Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | ME0062108 | FL |
NPI | 1205944097 |
---|---|
Provider Name | Attiya Ali |
First Address | Palm Bay, FL 32905-2937 |
Second Address | Palm Bay, FL 32905-2937 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 24/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
224328 | AMERIGROUP (01) | FL |
23941 | BCBS (01) | FL |
373757800 | (05) | FL |
4399726 | AETNA (01) | FL |