Provider Demographics
NPI:1164714135
Name:ABAS, ATIF O
Entity Type:Individual
Prefix:
First Name:ATIF
Middle Name:O
Last Name:ABAS
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 1:3113 W DESERT LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-3829
Mailing Address - Country:US
Mailing Address - Phone:062-639-3147
Mailing Address - Fax:602-374-4508
Practice Address - Street 1:3113 W DESERT LN
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-3829
Practice Address - Country:US
Practice Address - Phone:062-639-3147
Practice Address - Fax:602-374-4508
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL16769427343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)