Provider Demographics
NPI:1619223393
Name:ALI, FARZANA NAWAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:FARZANA
Middle Name:NAWAZ
Last Name:ALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W TURNER RD STE 450
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-2191
Mailing Address - Country:US
Mailing Address - Phone:209-370-1700
Mailing Address - Fax:209-373-2873
Practice Address - Street 1:2401 W TURNER RD STE 450
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-2191
Practice Address - Country:US
Practice Address - Phone:209-370-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA136163207Q00000X
CA136163207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine