Active NPI
Ali Etessam, D.P.T.
- Specialist
- Irvine, CA
National Provider Identifier
1558403733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- PT20329
- Practice address
- 3 Corporate Park Ste 165
Irvine, CA 92606-5161 - Phone
- (949) 207-7377
- Fax
- (949) 207-3227
- NPI assigned
- Feb 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | PT20329 | CA | Primary |
Addresses
Primary practice location
3 Corporate Park Ste 165
Irvine, CA 92606-5161
Mailing address
3 Corporate Park Ste 165
Irvine, CA 92606-5161
Phone (949) 207-7377
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT0203290 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT20329 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631750400000",
"number": "1558403733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 CORPORATE PARK STE 165",
"city": "IRVINE",
"state": "CA",
"postal_code": "926065161",
"telephone_number": "949-207-7377",
"fax_number": "949-207-3227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 CORPORATE PARK STE 165",
"city": "IRVINE",
"state": "CA",
"postal_code": "926065161",
"telephone_number": "949-207-7377",
"fax_number": "949-207-3227"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETESSAM",
"first_name": "ALI",
"credential": "D.P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-13",
"last_updated": "2021-09-16",
"certification_date": "2021-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "PT20329",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PT0203290",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Irvine, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.