Provider Demographics
NPI:1730663196
Name:ALI, MOHAMED SHERIF
Entity Type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:SHERIF
Last Name:ALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9635 BASELINE RD UNIT 230
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1359
Mailing Address - Country:US
Mailing Address - Phone:909-233-6829
Mailing Address - Fax:
Practice Address - Street 1:9635 BASELINE RD UNIT 230
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1359
Practice Address - Country:US
Practice Address - Phone:909-233-6829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA076581343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)