Provider Demographics
NPI:1164110086
Name:ELSIRAG, YOUSIF HUSSAIN ABDELWAHAB
Entity Type:Individual
Prefix:
First Name:YOUSIF
Middle Name:HUSSAIN ABDELWAHAB
Last Name:ELSIRAG
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 1:3135 S JOSHUA TREE LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-2770
Mailing Address - Country:US
Mailing Address - Phone:602-800-2132
Mailing Address - Fax:
Practice Address - Street 1:3135 S JOSHUA TREE LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-2770
Practice Address - Country:US
Practice Address - Phone:602-800-2132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)