Healthcare Provider Details

I. General information

NPI: 1982912804
Provider Name (Legal Business Name): ALI SOOZANI, D.O., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 SAMARITAN DR SUITE 855F
SAN JOSE CA
95124-4100
US

IV. Provider business mailing address

2577 SAMARITAN DR SUITE 855F
SAN JOSE CA
95124-4100
US

V. Phone/Fax

Practice location:
  • Phone: 408-402-9521
  • Fax: 408-402-9931
Mailing address:
  • Phone: 408-402-9521
  • Fax: 408-402-9931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A7210
License Number StateCA

VIII. Authorized Official

Name: ALI SOOZANI
Title or Position: PRESIDENT
Credential: D.O.
Phone: 408-402-9521