Provider Demographics
NPI:1114291366
Name:ALI TAJLIL MD INC
Entity Type:Organization
Organization Name:ALI TAJLIL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:TABRIZZI
Authorized Official - Last Name:TAJLIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-733-6890
Mailing Address - Street 1:3941 J STREET
Mailing Address - Street 2:SUITE 370
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3633
Mailing Address - Country:US
Mailing Address - Phone:916-733-6890
Mailing Address - Fax:916-733-6849
Practice Address - Street 1:3941 J STREET
Practice Address - Street 2:SUITE 370
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3633
Practice Address - Country:US
Practice Address - Phone:916-733-6890
Practice Address - Fax:916-733-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA378472086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A378470Medicaid
CAC03974Medicare UPIN
CA00A378470Medicaid