Provider Demographics
NPI:1619983533
Name:ELAHI, ALI (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:ELAHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 E COAST HWY STE 260
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1932
Mailing Address - Country:US
Mailing Address - Phone:949-652-7301
Mailing Address - Fax:949-652-7301
Practice Address - Street 1:2121 E COAST HWY STE 260
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-1932
Practice Address - Country:US
Practice Address - Phone:949-652-7301
Practice Address - Fax:949-652-7301
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA862672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA862670Medicaid
CAWA86267CMedicare ID - Type Unspecified
CAOOA862670Medicaid