Provider Demographics
NPI:1245789106
Name:ABDISALAN, ABDIKADIR
Entity Type:Individual
Prefix:
First Name:ABDIKADIR
Middle Name:
Last Name:ABDISALAN
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 1:5451 MANDARIN CV
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-6052
Mailing Address - Country:US
Mailing Address - Phone:619-358-5230
Mailing Address - Fax:
Practice Address - Street 1:5451 MANDARIN CV
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-6052
Practice Address - Country:US
Practice Address - Phone:619-358-5230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
344600000X
CAD3499448344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi