Organization
BANAIE MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALI BANAIE M.D. (SOLE PROPRIETOR)
(619) 469-5400
Entity
Organization
Contact information
Practice address
8860 CENTER DRIVE, SUITE 420, LA MESA, CA 91942-3020
(619) 469-5400
(619) 464-1311
Mailing address
8860 CENTER DRIVE, SUITE 420, LA MESA, CA 91942-3020
(619) 469-5400
(619) 464-1311
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A873080
—
CA
01
—
W17381
PTAN
CA
Enumeration date
07/13/2006
Last updated
11/10/2021
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