Provider Demographics
NPI:1982634887
Name:DR ALI TABATABAI MD INC A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DR ALI TABATABAI MD INC A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:TABATABAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-916-7600
Mailing Address - Street 1:23961 CALLE DE LA MAGDALENA
Mailing Address - Street 2:426
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3616
Mailing Address - Country:US
Mailing Address - Phone:949-916-7600
Mailing Address - Fax:949-916-7602
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA
Practice Address - Street 2:426
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3616
Practice Address - Country:US
Practice Address - Phone:949-916-7600
Practice Address - Fax:949-916-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16566Medicare ID - Type Unspecified