Healthcare Provider Details

I. General information

NPI: 1205971033
Provider Name (Legal Business Name): ALI ESLAMI MD. PHD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DR
LA JOLLA CA
92093-5004
US

IV. Provider business mailing address

3776 1ST AVE APT G
SAN DIEGO CA
92103-4030
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-4040
  • Fax:
Mailing address:
  • Phone: 619-241-4241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: