Healthcare Provider Details

I. General information

NPI: 1053226126
Provider Name (Legal Business Name): MOHAMED ALI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8756 MAST BLVD
SANTEE CA
92071-2046
US

IV. Provider business mailing address

13523 ZINNIA HILLS PL APT 56
SAN DIEGO CA
92130-5763
US

V. Phone/Fax

Practice location:
  • Phone: 619-956-0400
  • Fax:
Mailing address:
  • Phone: 858-309-2799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41564
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: