Provider Demographics
NPI:1285067009
Name:DAKHLALLAH, ALI (OT)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:DAKHLALLAH
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:DAKHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ALEX DAKHL
Mailing Address - Street 1:1010 UNIVERSITY AVE
Mailing Address - Street 2:STE 113-485
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3398
Mailing Address - Country:US
Mailing Address - Phone:310-439-0633
Mailing Address - Fax:
Practice Address - Street 1:3242 ASHFORD ST
Practice Address - Street 2:UNITE J
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-5056
Practice Address - Country:US
Practice Address - Phone:310-439-0633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1362224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant