Provider Demographics
NPI:1194375121
Name:HAJIALI, HAJI NOOR
Entity type:Individual
Prefix:
First Name:HAJI
Middle Name:NOOR
Last Name:HAJIALI
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 1:9821 APPLE ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-4665
Mailing Address - Country:US
Mailing Address - Phone:619-519-9282
Mailing Address - Fax:
Practice Address - Street 1:9821 APPLE ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-4665
Practice Address - Country:US
Practice Address - Phone:619-519-9282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
B8804611172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty