Individual
ALI HEIDARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
843 E FOOTHILL BLVD, UPLAND, CA 91786-4034
(909) 982-1002
Mailing address
1777 ATLANTA AVE, G6, RIVERSIDE, CA 92507-7417
(951) 682-8999
(951) 682-9019
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
20A6946
CA
Other
Enumeration date
08/19/2006
Last updated
07/08/2007
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