Provider Demographics
NPI:1164940185
Name:ALI, FADHL
Entity Type:Individual
Prefix:
First Name:FADHL
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 GOMEZ ST.
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:CA
Mailing Address - Zip Code:93640
Mailing Address - Country:US
Mailing Address - Phone:559-567-5946
Mailing Address - Fax:
Practice Address - Street 1:497 OLLER ST
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:CA
Practice Address - Zip Code:93640-2312
Practice Address - Country:US
Practice Address - Phone:559-382-2080
Practice Address - Fax:559-382-2161
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2021-12-22
Deactivation Date:2018-10-25
Deactivation Code:
Reactivation Date:2018-11-03
Provider Licenses
StateLicense IDTaxonomies
CARPH79676183500000X
390200000X
CA79676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program