Healthcare Provider Details

I. General information

NPI: 1841267994
Provider Name (Legal Business Name): ALIREZA JAMALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W AVENUE M4
PALMDALE CA
93551-1432
US

IV. Provider business mailing address

1120 W AVENUE M4
PALMDALE CA
93551-1432
US

V. Phone/Fax

Practice location:
  • Phone: 661-480-2377
  • Fax: 661-480-2378
Mailing address:
  • Phone: 661-480-2377
  • Fax: 661-480-2378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101028662
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: