Provider Demographics
NPI:1104013002
Name:ALI REZAPOUR, M.D., INC.
Entity Type:Organization
Organization Name:ALI REZAPOUR, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-353-3953
Mailing Address - Street 1:6769 N FRESNO ST
Mailing Address - Street 2:SUITE # 204
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-3715
Mailing Address - Country:US
Mailing Address - Phone:559-353-9353
Mailing Address - Fax:559-261-2610
Practice Address - Street 1:6769 N FRESNO ST
Practice Address - Street 2:SUITE # 204
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-3715
Practice Address - Country:US
Practice Address - Phone:559-353-9353
Practice Address - Fax:559-261-2610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA05242174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty