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General NPI Number Information
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NPI Number | 1518990274
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Entity Type | Individual
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Provider Name | SULTANALI A KASSAMALI M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 08/26/2019
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Provider Practice Location Address
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Address Line | 949 CALHOUN PL SUITE G
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City | HEMET
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State | CA
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Zip | 92543-4403
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Country | US
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Telephone | 951-929-1111
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Fax | 951-765-0361
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Provider Business Mailing Address
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Address Line | 13561 GINGER GLEN RD
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City | SAN DIEGO
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State | CA
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Zip | 92130-6913
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Country | US
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Telephone | 858-663-1845
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A32525
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License Number State | CA
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