Provider Demographics
NPI:1154365872
Name:DELBAKHSH, ALI (MD)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:DELBAKHSH
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 1:300 S PIERCE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4124
Mailing Address - Country:US
Mailing Address - Phone:619-668-4700
Mailing Address - Fax:619-668-0049
Practice Address - Street 1:300 S PIERCE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4124
Practice Address - Country:US
Practice Address - Phone:619-668-4700
Practice Address - Fax:619-668-0049
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10007278207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1154365872Medicaid
I121141Medicare UPIN
DE1154365872Medicaid
CABN688ZMedicare PIN