Provider Demographics
NPI:1700630787
Name:TAYYEB, ALI R (PHD, RN, FAAN)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:R
Last Name:TAYYEB
Suffix:
Gender:M
Credentials:PHD, RN, FAAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 CAMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90040-1501
Mailing Address - Country:US
Mailing Address - Phone:234-822-2103
Mailing Address - Fax:
Practice Address - Street 1:2035 CAMFIELD AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90040-1501
Practice Address - Country:US
Practice Address - Phone:234-822-2103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA707108163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development