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General NPI Number Information
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NPI Number | 1144603358
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Entity Type | Individual
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Provider Name | NIMA JALALI
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Gender | Male
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 2400 E 4TH ST
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2026
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Country | US
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Telephone | 619-470-4141
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 E 4TH ST
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2026
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number | A160549
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A160549
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License Number State | CA
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