Healthcare Provider Details

I. General information

NPI: 1154447902
Provider Name (Legal Business Name): ALI MARNI STROCKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18425 BURBANK BLVD SUITE 412
TARZANA CA
91356-2806
US

IV. Provider business mailing address

18425 BURBANK BLVD SUITE 412
TARZANA CA
91356-2806
US

V. Phone/Fax

Practice location:
  • Phone: 818-905-8118
  • Fax: 818-905-8527
Mailing address:
  • Phone: 818-905-8118
  • Fax: 818-905-8527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberA81361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: