Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | A47735 | CA |
NPI | 1063411684 |
---|---|
Provider Name | Sultanali Alidina |
First Address | Lakewood, CA 90805-4549 |
Second Address | Lakewood, CA 90805-4549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2005 |
Last Update Date | 27/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A477350 | (05) | CA |
E96634 | (02) |