Provider Demographics
NPI:1790088177
Name:DHIA A M AL-WARDI M D INC
Entity Type:Organization
Organization Name:DHIA A M AL-WARDI M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DHIA
Authorized Official - Middle Name:A M
Authorized Official - Last Name:AL-WARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-281-7775
Mailing Address - Street 1:225 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3403
Mailing Address - Country:US
Mailing Address - Phone:626-281-7775
Mailing Address - Fax:626-281-2574
Practice Address - Street 1:225 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3403
Practice Address - Country:US
Practice Address - Phone:626-281-7775
Practice Address - Fax:626-281-2574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA25184Medicare UPIN