Individual
ALI ETESSAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.T.
Contact information
Practice address
3 CORPORATE PARK STE 165, IRVINE, CA 92606-5161
(949) 207-7377
(949) 207-3227
Mailing address
3 CORPORATE PARK STE 165, IRVINE, CA 92606-5161
(949) 207-7377
(949) 207-3227
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT20329
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PT0203290
—
CA
Enumeration date
02/13/2007
Last updated
09/16/2021
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