Healthcare Provider Details

I. General information

NPI: 1164767992
Provider Name (Legal Business Name): ALI NEMAT, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

11420 SANTA MONICA BLVD 25336
LOS ANGELES CA
90025-8807
US

V. Phone/Fax

Practice location:
  • Phone: 562-200-3237
  • Fax: 562-595-5282
Mailing address:
  • Phone: 310-467-5224
  • Fax: 562-595-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA74814
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA74814
License Number StateCA

VIII. Authorized Official

Name: ALI NEMAT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-467-5224