Provider Demographics
NPI:1700913951
Name:FATIGH, ALI
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:FATIGH
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 1:2035 E BALL RD
Mailing Address - Street 2:SUITE 100C
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-5159
Mailing Address - Country:US
Mailing Address - Phone:714-517-6105
Mailing Address - Fax:714-517-6139
Practice Address - Street 1:2035 E BALL RD
Practice Address - Street 2:SUITE 100C
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5159
Practice Address - Country:US
Practice Address - Phone:714-517-6105
Practice Address - Fax:714-517-6139
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85978106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist