Provider Demographics
NPI:1073964037
Name:IRIMIA, MIHAI
Entity Type:Individual
Prefix:
First Name:MIHAI
Middle Name:
Last Name:IRIMIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 E LEWIS LN
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-8846
Mailing Address - Country:US
Mailing Address - Phone:208-468-8742
Mailing Address - Fax:
Practice Address - Street 1:1324 E LEWIS LN
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-8846
Practice Address - Country:US
Practice Address - Phone:208-468-8742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID45-1291404343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)