Provider Demographics
NPI:1164854089
Name:BADRAN, AHMED
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:BADRAN
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 1:4141 W ROSECRANS AVE
Mailing Address - Street 2:APT #106
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-7257
Mailing Address - Country:US
Mailing Address - Phone:310-978-7248
Mailing Address - Fax:888-679-8890
Practice Address - Street 1:4141 W ROSECRANS AVE
Practice Address - Street 2:APT #106
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-7257
Practice Address - Country:US
Practice Address - Phone:310-978-7248
Practice Address - Fax:888-679-8890
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSG0028872343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)