Healthcare Provider Details

I. General information

NPI: 1356056154
Provider Name (Legal Business Name): ALI M. STROCKER, M.D. A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18425 BURBANK BLVD STE 412
TARZANA CA
91356-6912
US

IV. Provider business mailing address

18425 BURBANK BLVD STE 412
TARZANA CA
91356-6912
US

V. Phone/Fax

Practice location:
  • Phone: 818-905-8118
  • Fax: 818-905-8527
Mailing address:
  • Phone: 818-905-1195
  • Fax: 818-905-8527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALI STROCKER
Title or Position: PHYSICIAN
Credential: MD
Phone: 818-905-1198