Provider Demographics
NPI:1376722736
Name:ALI, ALTAF LUTFE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALTAF
Middle Name:LUTFE
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 1:5365 WALNUT AVE
Mailing Address - Street 2:STE. L
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2622
Mailing Address - Country:US
Mailing Address - Phone:909-591-7395
Mailing Address - Fax:909-591-5097
Practice Address - Street 1:5365 WALNUT AVE
Practice Address - Street 2:STE. L
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2622
Practice Address - Country:US
Practice Address - Phone:909-591-7395
Practice Address - Fax:909-591-5097
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42679207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A426791Medicaid
E43515Medicare UPIN
00A426790Medicare PIN