Provider Demographics
NPI:1316364649
Name:ISSA, ZIAD
Entity Type:Individual
Prefix:MR
First Name:ZIAD
Middle Name:
Last Name:ISSA
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:PO BOX 14525
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-4525
Mailing Address - Country:US
Mailing Address - Phone:318-623-2050
Mailing Address - Fax:318-787-6810
Practice Address - Street 1:119 WOODLAKE DR
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4762
Practice Address - Country:US
Practice Address - Phone:318-305-2023
Practice Address - Fax:318-787-6810
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)