Basic Information
Provider Information | |||||||||
NPI: | 1326363565 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HASSANALI | ||||||||
FirstName: | SALIMA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O., MPH | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 75 REMITTANCE DR | ||||||||
Address2: | DEPARTMENT 6008 | ||||||||
City: | CHICAGO | ||||||||
State: | IL | ||||||||
PostalCode: | 606756008 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5622821419 | ||||||||
FaxNumber: | 5629204642 | ||||||||
Practice Location | |||||||||
Address1: | 3851 KATELLA AVE | ||||||||
Address2: | STE 155 | ||||||||
City: | LOS ALAMITOS | ||||||||
State: | CA | ||||||||
PostalCode: | 907203309 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5623441350 | ||||||||
FaxNumber: | 5623441354 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/31/2010 | ||||||||
LastUpdateDate: | 12/02/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | DO 1585 | NV | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 20A11645 | CA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 1326363565 | 05 | NV |   | MEDICAID |