Provider Demographics
NPI:1912032343
Name:ALI, RAZAA A (DC)
Entity Type:Individual
Prefix:DR
First Name:RAZAA
Middle Name:A
Last Name:ALI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2937 UNION AVE # B
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-1439
Mailing Address - Country:US
Mailing Address - Phone:408-559-0771
Mailing Address - Fax:408-559-2043
Practice Address - Street 1:2937 UNION AVE # B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-1439
Practice Address - Country:US
Practice Address - Phone:408-559-0771
Practice Address - Fax:408-559-2043
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0207560Medicare PIN