Provider Demographics
NPI:1962513846
Name:ALI, ALIYA IMRAN (MD)
Entity type:Individual
Prefix:MRS
First Name:ALIYA
Middle Name:IMRAN
Last Name:ALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12826 PHILADELPHIA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-4126
Mailing Address - Country:US
Mailing Address - Phone:562-789-9908
Mailing Address - Fax:562-789-9418
Practice Address - Street 1:12826 PHILADELPHIA ST
Practice Address - Street 2:SUITE A
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4126
Practice Address - Country:US
Practice Address - Phone:562-789-9908
Practice Address - Fax:562-789-9418
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50859208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50859OtherLICENSE NUMBER