Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | F404 | CA |
Y | 2088P0231X | Pediatric Urologist | F404 | CA |
NPI | 1053783860 |
---|---|
Provider Name | Ahmed Abdelhalim Abdelaziz Ali |
First Address | Los Angeles, CA 90051-5642 |
Second Address | Orange, CA 92868-4509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2015 |
Last Update Date | 21/10/2015 |