Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 167813 | CA |
NPI | 1255852109 |
---|---|
Provider Name | Ali Chakari |
First Address | Tracy, CA 95377-8422 |
Second Address | Tracy, CA 95377-8422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2017 |
Last Update Date | 30/06/2017 |