Provider Demographics
NPI:1861888794
Name:ABIDALI, ALI (DO)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:ABIDALI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154A W FOOTHILL BLVD # 372
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3847
Mailing Address - Country:US
Mailing Address - Phone:480-251-5441
Mailing Address - Fax:
Practice Address - Street 1:500 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4734
Practice Address - Country:US
Practice Address - Phone:909-757-8425
Practice Address - Fax:909-757-8392
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.014908204F00000X
AZ008110207Q00000X
390200000X
CA20A20785208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program