Provider Demographics
NPI:1407194608
Name:SOUDAH, ANWAR AKRAM (BSC)
Entity Type:Individual
Prefix:MR
First Name:ANWAR
Middle Name:AKRAM
Last Name:SOUDAH
Suffix:
Gender:M
Credentials:BSC
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Mailing Address - Street 1:6501 W CHARLESTON BLVD
Mailing Address - Street 2:APT C197
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1006
Mailing Address - Country:US
Mailing Address - Phone:702-619-2533
Mailing Address - Fax:
Practice Address - Street 1:6501 W CHARLESTON BLVD
Practice Address - Street 2:APT C197
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1006
Practice Address - Country:US
Practice Address - Phone:702-619-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner