Provider Demographics
NPI:1861579534
Name:TAJLIL, ALI TABRIZZI (MD)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:TABRIZZI
Last Name:TAJLIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3941 J ST
Mailing Address - Street 2:SUITE 370
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3628
Mailing Address - Country:US
Mailing Address - Phone:916-733-6890
Mailing Address - Fax:916-733-6849
Practice Address - Street 1:3941 J ST
Practice Address - Street 2:SUITE 370
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3624
Practice Address - Country:US
Practice Address - Phone:916-733-6890
Practice Address - Fax:916-733-6849
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3784702086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A378470Medicaid
CA00A378470Medicaid
CA00A378470Medicare ID - Type Unspecified