Provider Demographics
NPI:1457603185
Name:DEHBOZORGI, ALI
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:DEHBOZORGI
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 1:4012 CALLE SONORA OESTE
Mailing Address - Street 2:UNIT 3B
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-3217
Mailing Address - Country:US
Mailing Address - Phone:949-527-8457
Mailing Address - Fax:949-527-8457
Practice Address - Street 1:4012 CALLE SONORA OESTE
Practice Address - Street 2:UNIT 3B
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-3249
Practice Address - Country:US
Practice Address - Phone:949-527-8457
Practice Address - Fax:949-527-8457
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBCBA1-09-6404103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst