Healthcare Provider Details

I. General information

NPI: 1710954706
Provider Name (Legal Business Name): ALI S. VAZIRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 TRANCAS ST STE 1C
NAPA CA
94558-2942
US

IV. Provider business mailing address

935 TRANCAS ST STE 1C
NAPA CA
94558-2942
US

V. Phone/Fax

Practice location:
  • Phone: 707-255-8207
  • Fax: 707-255-4628
Mailing address:
  • Phone: 707-255-8207
  • Fax: 707-255-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG71962
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberG71962
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: