Provider Demographics
NPI:1518240373
Name:ALI SADRIEH, DPM, INC.
Entity Type:Organization
Organization Name:ALI SADRIEH, DPM, INC.
Other - Org Name:EVO ADVANCED FOOT SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SADRIEH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-691-5411
Mailing Address - Street 1:PO BOX 1360
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91614-0360
Mailing Address - Country:US
Mailing Address - Phone:310-691-5411
Mailing Address - Fax:
Practice Address - Street 1:12265 VENTURA BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2528
Practice Address - Country:US
Practice Address - Phone:310-691-5411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty