Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | A146896 | CA |
NPI | 1013423631 |
---|---|
Provider Name | Abdul Ali Qaderi |
First Address | San Diego, CA 92114-3909 |
Second Address | Los Angeles, CA 90048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2017 |
Last Update Date | 19/12/2017 |