Healthcare Provider Details

I. General information

NPI: 1851279434
Provider Name (Legal Business Name): HATEM ALI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 09/21/2025
Certification Date: 09/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 S CHURCH ST APT 22
LODI CA
95240-6291
US

IV. Provider business mailing address

1918 S CHURCH ST APT 22
LODI CA
95240-6291
US

V. Phone/Fax

Practice location:
  • Phone: 209-233-6000
  • Fax:
Mailing address:
  • Phone: 209-233-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: