Provider Demographics
NPI:1639225154
Name:ALI, KANEEZ (PA)
Entity Type:Individual
Prefix:
First Name:KANEEZ
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7270
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92552-7270
Mailing Address - Country:US
Mailing Address - Phone:951-656-1500
Mailing Address - Fax:951-656-1510
Practice Address - Street 1:215 W 4TH ST
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-2010
Practice Address - Country:US
Practice Address - Phone:951-943-4751
Practice Address - Fax:951-657-3522
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA133962080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine