Healthcare Provider Details

I. General information

NPI: 1861875429
Provider Name (Legal Business Name): ALI POURDJABBAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9434 MEDICAL CENTER DRIVE UC SAN DIEGO DIVISION OF CARDIOVASCULAR MEDICINEC
LA JOLLA CA
92037
US

IV. Provider business mailing address

3535 LEBON DR APT 2301
SAN DIEGO CA
92122-4595
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-5378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA134134
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: