=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811097843
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WAZIR ALI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2006
-----------------------------------------------------
Last Update Date | 02/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13132 STUDEBAKER ROAD SUITE 9
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-863-1012
-----------------------------------------------------
Fax | 562-868-0916
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13132 STUDEBAKER ROAD SUITE 9
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-863-1012
-----------------------------------------------------
Fax | 562-868-0916
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | G83188
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------