Provider Demographics
NPI:1962404723
Name:ALIABADI, DAVID GERARD (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GERARD
Last Name:ALIABADI
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 1:2220 LYNN RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1904
Mailing Address - Country:US
Mailing Address - Phone:805-494-9494
Mailing Address - Fax:805-496-5631
Practice Address - Street 1:2220 LYNN RD
Practice Address - Street 2:SUITE 208
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1904
Practice Address - Country:US
Practice Address - Phone:805-494-9494
Practice Address - Fax:805-496-5631
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69896207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ94648ZOtherBLUE SHIELD
CA00G698960Medicaid
CA95354702891403B002OtherTRICARE WEST REGION
CAG08897Medicare UPIN
CAWG69896BMedicare ID - Type Unspecified