Provider Demographics
NPI:1225830540
Name:ALI, LIBAN MOHAMED (SUDRC)
Entity type:Individual
Prefix:MR
First Name:LIBAN
Middle Name:MOHAMED
Last Name:ALI
Suffix:
Gender:
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1638
Mailing Address - Country:US
Mailing Address - Phone:626-398-3897
Mailing Address - Fax:
Practice Address - Street 1:750 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1638
Practice Address - Country:US
Practice Address - Phone:626-398-3897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20973101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)