Provider Demographics
NPI:1376048983
Name:DIRIRSA, ABDISSA A
Entity Type:Individual
Prefix:
First Name:ABDISSA
Middle Name:A
Last Name:DIRIRSA
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 1:5158 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-2075
Mailing Address - Country:US
Mailing Address - Phone:720-951-9020
Mailing Address - Fax:
Practice Address - Street 1:5158 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-2075
Practice Address - Country:US
Practice Address - Phone:720-951-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)