Provider Demographics
NPI:1235633942
Name:ALSUBAIHAWI, AHMED
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:ALSUBAIHAWI
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 1:7480 TELLER ST
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-2752
Mailing Address - Country:US
Mailing Address - Phone:720-975-7909
Mailing Address - Fax:
Practice Address - Street 1:7480 TELLER ST
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-2752
Practice Address - Country:US
Practice Address - Phone:720-975-7909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04Y6823747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000142959Medicaid