Organization
ALI A HEIDARI, DO, A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALI A HEIDARI DO (PRESIDENT)
(909) 982-1002
Entity
Organization
Contact information
Practice address
843 E FOOTHILL BLVD, UPLAND, CA 91786-4034
(909) 982-1002
Mailing address
843 E FOOTHILL BLVD, UPLAND, CA 91786-4034
(909) 982-1002
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
20A6946
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20A6946
ST LICENSE
CA
Enumeration date
01/16/2008
Last updated
06/02/2016
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