| Ali M. Etemadian, D.o., Inc. | |
|
5343 Riverside Dr Chino CA 91710-4252 | |
| (909) 591-6227 | |
| (909) 591-6319 |
| Full Name | Ali M. Etemadian, D.o., Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 5343 Riverside Dr, Chino, California |
| Authorized Official Name and Position | Ali M. Etemadian (OWNER) |
| Authorized Official Contact | 9095916227 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ali M. Etemadian, D.o., Inc. 5343 Riverside Dr Chino CA 91710-4252 Ph: (909) 591-6227 | Ali M. Etemadian, D.o., Inc. 5343 Riverside Dr Chino CA 91710-4252 Ph: (909) 591-6227 |
| NPI Number | 1477694156 |
|---|---|
| Provider Enumeration Date | 02/08/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 3779759618 |
|---|---|
| Medicare Enrollment ID | O20111227000585 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477694156 | NPI | - | NPPES |
| 00AX63770 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 20A6377 (California) | Primary |
| Provider Name | Ali M Etemadian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316041718 PECOS PAC ID: 5294625448 Enrollment ID: I20040319000377 |
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