Healthcare Provider Details

I. General information

NPI: 1245257948
Provider Name (Legal Business Name): ALI HAFEZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12401 WASHINGTON BLVD
WHITTIER CA
90602-1006
US

IV. Provider business mailing address

12401 WASHINGTON BLVD
WHITTIER CA
90602-1006
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-0811
  • Fax: 562-698-7624
Mailing address:
  • Phone: 562-698-0811
  • Fax: 562-698-7624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberG70333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: