Provider Demographics
NPI:1346570934
Name:PEARL CARE INC
Entity type:Organization
Organization Name:PEARL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-881-1595
Mailing Address - Street 1:16161 VENTURA BLVD
Mailing Address - Street 2:SUITE C, PMB 702
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2522
Mailing Address - Country:US
Mailing Address - Phone:760-881-1595
Mailing Address - Fax:
Practice Address - Street 1:12637 HESPERIA RD
Practice Address - Street 2:SUITE 252
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7774
Practice Address - Country:US
Practice Address - Phone:760-881-1595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty