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General NPI Number Information
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NPI Number | 1366765497
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Entity Type | Organization
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Legal Business Name | MOHSEN I ALI M D INC
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Dates
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Enumeration Date | 03/03/2010
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 1330 W COVINA BLVD SUITE 103
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City | SAN DIMAS
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State | CA
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Zip | 91773-3200
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Country | US
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Telephone | 909-592-2145
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Fax | 909-599-6217
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Provider Business Mailing Address
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Address Line | PO BOX 4438
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91729-4438
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Country | US
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Telephone | 909-592-2145
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Fax | 909-599-6217
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Authorized Official
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Title or Position | OWNER
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Name | DR. MOHSEN IBRAHIM ALI
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Credential |
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Telephone | 909-592-2145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | A33406
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License Number State | CA
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