Provider Demographics
NPI:1093577793
Name:ASAMOAH, FAAFETAI
Entity Type:Individual
Prefix:
First Name:FAAFETAI
Middle Name:
Last Name:ASAMOAH
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 1:1704 S 39TH ST UNIT 24
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3844
Mailing Address - Country:US
Mailing Address - Phone:480-512-9393
Mailing Address - Fax:
Practice Address - Street 1:1704 S 39TH ST UNIT 24
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3844
Practice Address - Country:US
Practice Address - Phone:480-512-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)