Provider Demographics
NPI:1073995361
Name:MOHAMMADI, ALI
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:MOHAMMADI
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 1:3902 S YOSEMITE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1925
Mailing Address - Country:US
Mailing Address - Phone:303-745-2114
Mailing Address - Fax:
Practice Address - Street 1:3902 S YOSEMITE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-1925
Practice Address - Country:US
Practice Address - Phone:303-745-2114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21503311343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)