Provider Demographics
NPI:1689451114
Name:ALI ABIDALI DO PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ALI ABIDALI DO PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:CALIFORNIA SURGICAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIDALI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-251-5441
Mailing Address - Street 1:154A W FOOTHILL BLVD # 372
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3847
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4734
Practice Address - Country:US
Practice Address - Phone:909-757-8425
Practice Address - Fax:909-757-8392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-08
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No204F00000XAllopathic & Osteopathic PhysiciansTransplant SurgeryGroup - Multi-Specialty