Provider Demographics
NPI:1306814868
Name:MESIWALA, ALI HAKIM (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:HAKIM
Last Name:MESIWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:840 TOWNE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5900
Mailing Address - Country:US
Mailing Address - Phone:909-398-1550
Mailing Address - Fax:909-398-1488
Practice Address - Street 1:9170 HAVEN AVE STE 108
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5416
Practice Address - Country:US
Practice Address - Phone:909-948-9754
Practice Address - Fax:909-948-8960
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042260207T00000X
CAA87133207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB224952Medicare PIN
CA00A871330Medicaid
I15167Medicare UPIN