Provider Demographics
NPI:1417577958
Name:WARRIACH, ALI NASIR
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:NASIR
Last Name:WARRIACH
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 1:3333 MEADOWLANDS LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1637
Mailing Address - Country:US
Mailing Address - Phone:408-707-5622
Mailing Address - Fax:
Practice Address - Street 1:871 COLEMAN AVE # 209
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-1831
Practice Address - Country:US
Practice Address - Phone:408-707-5622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty