Provider Demographics
NPI:1992277818
Name:NEDALI 99, LLC
Entity type:Organization
Organization Name:NEDALI 99, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOJAVERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-935-4056
Mailing Address - Street 1:13065 W MCDOWELL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-6439
Mailing Address - Country:US
Mailing Address - Phone:623-935-4056
Mailing Address - Fax:623-935-2018
Practice Address - Street 1:5401 E MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-2523
Practice Address - Country:US
Practice Address - Phone:236-283-2016
Practice Address - Fax:480-361-3431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-18
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty