Provider Demographics
NPI:1518026939
Name:MOSTAFAVI, ALI A (DC,QME)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:A
Last Name:MOSTAFAVI
Suffix:
Gender:M
Credentials:DC,QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 E 1ST ST STE A
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3852
Mailing Address - Country:US
Mailing Address - Phone:949-756-1003
Mailing Address - Fax:949-756-1008
Practice Address - Street 1:1076 E 1ST ST STE A
Practice Address - Street 2:SUITE A
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3852
Practice Address - Country:US
Practice Address - Phone:949-756-1003
Practice Address - Fax:949-756-1004
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 24685111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor