Provider Demographics
NPI:1578756409
Name:ALEXANDER CARLI, M.D., F.A.C.S., INC.
Entity Type:Organization
Organization Name:ALEXANDER CARLI, M.D., F.A.C.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:951-688-8660
Mailing Address - Street 1:10694 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-1816
Mailing Address - Country:US
Mailing Address - Phone:951-688-8660
Mailing Address - Fax:951-688-2803
Practice Address - Street 1:10694 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-1816
Practice Address - Country:US
Practice Address - Phone:951-688-8660
Practice Address - Fax:951-688-2803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37286174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06026ZMedicare PIN