Provider Demographics
NPI:1083310015
Name:ALI, SIMONE MICHELE
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:MICHELE
Last Name:ALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 NAKOMIS DR NE UNIT C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-6079
Mailing Address - Country:US
Mailing Address - Phone:505-263-1738
Mailing Address - Fax:
Practice Address - Street 1:3150 CARLISLE BLVD NE STE 105
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1680
Practice Address - Country:US
Practice Address - Phone:505-633-8173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1491175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist