Provider Demographics
NPI:1447296462
Name:NEMAT, ALI (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:NEMAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAMMAD
Other - Middle Name:ALI
Other - Last Name:NEMATBAKHSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1511 CAMDEN AVE
Mailing Address - Street 2:PH1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-8034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:SUITE 3450
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-6906
Practice Address - Fax:323-442-6255
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA748142081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A748140Medicaid
CA00A748140328OtherCALOPTIMA
CA050089889OtherRAILROAD MEDICARE
CA0A4748140OtherBLUE SHIELD
CA00A748140328OtherCALOPTIMA
CA00A748140Medicaid