Provider Demographics
NPI:1376234765
Name:GHEZAI, MUSSIE
Entity Type:Individual
Prefix:
First Name:MUSSIE
Middle Name:
Last Name:GHEZAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MUSSIE
Other - Middle Name:
Other - Last Name:GHEZAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2010 W ALTA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-5445
Mailing Address - Country:US
Mailing Address - Phone:602-908-2041
Mailing Address - Fax:
Practice Address - Street 1:2010 W ALTA VISTA RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-5445
Practice Address - Country:US
Practice Address - Phone:602-908-2041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)