Provider Demographics
NPI:1700849049
Name:ALI, MUMTAZ A (MD)
Entity Type:Individual
Prefix:DR
First Name:MUMTAZ
Middle Name:A
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7439 LA PALMA AVE
Mailing Address - Street 2:STE#302
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-2658
Mailing Address - Country:US
Mailing Address - Phone:714-741-2929
Mailing Address - Fax:714-741-2926
Practice Address - Street 1:12665 GARDEN GROVE BLVD
Practice Address - Street 2:STE#606
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1901
Practice Address - Country:US
Practice Address - Phone:714-741-2929
Practice Address - Fax:714-741-2926
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA043472174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist