Provider Demographics
NPI:1922829472
Name:AHMADZAI, ALI (NP)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:AHMADZAI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 MOUNT ADA RD UNIT 126
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3151
Mailing Address - Country:US
Mailing Address - Phone:909-576-3419
Mailing Address - Fax:
Practice Address - Street 1:6555 MOUNT ADA RD UNIT 126
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3151
Practice Address - Country:US
Practice Address - Phone:909-576-3419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032371363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily