Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | A90764 | CA |
N | 2084N0600X | Clinical Neurophysiologist | A90764 | CA |
NPI | 1174848238 |
---|---|
Provider Name | Dr. Ali Mostajelean |
First Address | Oakland, CA 94609-1809 |
Second Address | Oakland, CA 94609-1809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2010 |
Last Update Date | 04/04/2012 |