Provider Demographics
NPI:1316791304
Name:ALI, ABOOZAR TAIYEB (DO)
Entity type:Individual
Prefix:
First Name:ABOOZAR
Middle Name:TAIYEB
Last Name:ALI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6525 W SACK DR STE 302
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7107
Mailing Address - Country:US
Mailing Address - Phone:623-561-7983
Mailing Address - Fax:
Practice Address - Street 1:6525 W SACK DR STE 302
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7107
Practice Address - Country:US
Practice Address - Phone:623-561-7983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program