Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | A43523 | CA |
NPI | 1205893245 |
---|---|
Provider Name | Habib Ali Ismail |
First Address | San Dimas, CA 91773-3200 |
Second Address | San Dimas, CA 91773-3200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 05/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A43523 | (05) | CA |
E01679 | (02) |