Provider Demographics
NPI:1215009113
Name:ALI, ASHMEAD (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHMEAD
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78625207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM18534GMedicaid
CARHM18534GMedicaid
G06444Medicare UPIN