Provider Demographics
NPI:1699788240
Name:SABBAGHI, ALI (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:SABBAGHI
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 1:3392 MOTOR AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3712
Mailing Address - Country:US
Mailing Address - Phone:310-202-1133
Mailing Address - Fax:310-202-1139
Practice Address - Street 1:3392 MOTOR AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3712
Practice Address - Country:US
Practice Address - Phone:310-202-1133
Practice Address - Fax:310-202-1139
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69120208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A691200Medicaid
CAA69120Medicare ID - Type Unspecified
CA00A691200Medicaid