Provider Demographics
NPI:1609053487
Name:ALI, AMENA MASOOD (BS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMENA
Middle Name:MASOOD
Last Name:ALI
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Gender:F
Credentials:BS, PA-C
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Mailing Address - Street 1:23672 BIRTCHER DR
Mailing Address - Street 2:UNIT A
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1711
Mailing Address - Country:US
Mailing Address - Phone:949-770-7301
Mailing Address - Fax:949-770-0634
Practice Address - Street 1:23672 BIRTCHER DR
Practice Address - Street 2:UNIT A
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1711
Practice Address - Country:US
Practice Address - Phone:949-770-7301
Practice Address - Fax:949-770-0634
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2014-12-10
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Provider Licenses
StateLicense IDTaxonomies
CAPA 19554363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical