Provider Demographics
NPI:1285798298
Name:ABOLFAZLI, ALI (NP)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:ABOLFAZLI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:580 CALIFORNIA ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-1071
Mailing Address - Country:US
Mailing Address - Phone:415-993-0295
Mailing Address - Fax:415-549-8670
Practice Address - Street 1:580 CALIFORNIA ST STE 1200
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-1071
Practice Address - Country:US
Practice Address - Phone:415-993-0295
Practice Address - Fax:415-549-8670
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA22081363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health