Provider Demographics
NPI:1093898454
Name:ASHMEAD ALI
Entity Type:Organization
Organization Name:ASHMEAD ALI
Other - Org Name:CAL CITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHMEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-373-1256
Mailing Address - Street 1:41019 WOODSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-5746
Mailing Address - Country:US
Mailing Address - Phone:760-373-1256
Mailing Address - Fax:760-373-1214
Practice Address - Street 1:9300 N LOOP BLVD
Practice Address - Street 2:SUITE A & B
Practice Address - City:CALIFORNIA CITY
Practice Address - State:CA
Practice Address - Zip Code:93505-2269
Practice Address - Country:US
Practice Address - Phone:760-373-1256
Practice Address - Fax:760-373-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-21
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG078625207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG078625OtherMEDICAL LICENSE
CA55-3894Medicare PIN