Provider Demographics
NPI:1033976360
Name:ABDULJAWAD, NOUR ADNAN
Entity Type:Individual
Prefix:
First Name:NOUR
Middle Name:ADNAN
Last Name:ABDULJAWAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 S DIXIE HWY APT A522
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4870
Mailing Address - Country:US
Mailing Address - Phone:305-733-7389
Mailing Address - Fax:
Practice Address - Street 1:235 S DIXIE HWY APT A522
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33133-4870
Practice Address - Country:US
Practice Address - Phone:305-733-7389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24-330265106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician