Provider Demographics
NPI:1386613206
Name:BANAIE, ALI (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:BANAIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8860 CENTER DRIVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3020
Mailing Address - Country:US
Mailing Address - Phone:619-469-5400
Mailing Address - Fax:619-464-1311
Practice Address - Street 1:8860 CENTER DRIVE
Practice Address - Street 2:SUITE 420
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3020
Practice Address - Country:US
Practice Address - Phone:619-469-5400
Practice Address - Fax:619-464-1311
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT98403207RG0100X
CAA87308207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A873080Medicaid
CAI08854Medicare UPIN
CAWA87308AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER