Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 32556 | CA |
NPI | 1316287642 |
---|---|
Provider Name | Dr. Tabassum Ali |
First Address | Seal Beach, CA 90740-6164 |
Second Address | Lakewood, CA 90712-1043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2013 |
Last Update Date | 07/01/2015 |