Provider Demographics
NPI:1588690994
Name:GHAHRAMAN, ALI REZA (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:REZA
Last Name:GHAHRAMAN
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 1:71 TIMBERLAND
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2108
Mailing Address - Country:US
Mailing Address - Phone:949-581-2002
Mailing Address - Fax:949-581-2221
Practice Address - Street 1:24881 ALICIA PKWY STE N
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4617
Practice Address - Country:US
Practice Address - Phone:949-581-2002
Practice Address - Fax:949-581-2221
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38989207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWC38989AMedicare ID - Type Unspecified
CAB53054Medicare UPIN