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General NPI Number Information
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NPI Number | 1164520581
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Entity Type | Individual
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Provider Name | MOHAMMAD ALI ANSARI M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 05/29/2013
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Provider Practice Location Address
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Address Line | 6310 SAN VICENTE BLVD SUITE 280
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City | LOS ANGELES
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State | CA
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Zip | 90048-5426
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Country | US
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Telephone | 323-934-9265
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Fax | 323-934-9266
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Provider Business Mailing Address
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Address Line | PO BOX 935
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City | BEVERLY HILLS
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State | CA
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Zip | 90213-0935
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Country | US
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Telephone | 310-433-2750
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | G75046
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License Number State | CA
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