Provider Demographics
NPI:1215758602
Name:ALI, AYAN A
Entity type:Individual
Prefix:
First Name:AYAN
Middle Name:A
Last Name:ALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9671 SW BARBUR BLVD APT 60
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-6015
Mailing Address - Country:US
Mailing Address - Phone:503-496-6349
Mailing Address - Fax:
Practice Address - Street 1:9671 SW BARBUR BLVD APT 60
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-6015
Practice Address - Country:US
Practice Address - Phone:503-496-6349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider