Provider Demographics
NPI:1194020057
Name:ATTAYA MEDICAL PLLC
Entity Type:Organization
Organization Name:ATTAYA MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAYDER
Authorized Official - Middle Name:K
Authorized Official - Last Name:ABDELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-317-9100
Mailing Address - Street 1:PO BOX 4788
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2442
Mailing Address - Country:US
Mailing Address - Phone:928-317-9100
Mailing Address - Fax:928-317-9300
Practice Address - Street 1:2400 S AVENUE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7127
Practice Address - Country:US
Practice Address - Phone:928-317-9100
Practice Address - Fax:928-317-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28692207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH26819Medicare UPIN
AZZ143166Medicare PIN