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General NPI Number Information
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NPI Number | 1326224692
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Entity Type | Organization
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Legal Business Name | ALI A HEIDARI, DO, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 06/02/2016
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Provider Practice Location Address
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Address Line | 843 E FOOTHILL BLVD
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City | UPLAND
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State | CA
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Zip | 91786-4034
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Country | US
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Telephone | 909-982-1002
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Fax |
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Provider Business Mailing Address
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Address Line | 843 E FOOTHILL BLVD
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City | UPLAND
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State | CA
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Zip | 91786-4034
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Country | US
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Telephone | 909-982-1002
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALI A HEIDARI
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Credential | DO
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Telephone | 909-982-1002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 20A6946
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License Number State | CA
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