Provider Demographics
NPI:1265458640
Name:ALALI, ALBORZ (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBORZ
Middle Name:
Last Name:ALALI
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 1:515 FAIRCHILD CT
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-5164
Mailing Address - Country:US
Mailing Address - Phone:530-666-1631
Mailing Address - Fax:
Practice Address - Street 1:515 FAIRCHILD CT
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-5164
Practice Address - Country:US
Practice Address - Phone:530-666-1631
Practice Address - Fax:530-662-3059
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71691207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA716910OtherBLUE SHIELD
CA00A716910Medicaid
CA00A716910Medicare ID - Type Unspecified
CA00A4716911Medicare PIN
CAOOA716910OtherBLUE SHIELD
H78066Medicare UPIN