Healthcare Provider Details

I. General information

NPI: 1144603358
Provider Name (Legal Business Name): NIMA JALALI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 E 4TH ST
NATIONAL CITY CA
91950-2026
US

IV. Provider business mailing address

2400 E 4TH ST
NATIONAL CITY CA
91950-2026
US

V. Phone/Fax

Practice location:
  • Phone: 619-470-4141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberA160549
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA160549
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: