Provider Demographics
NPI:1467011973
Name:ABEDI, SYED ADEEL (MANAGER)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:ADEEL
Last Name:ABEDI
Suffix:
Gender:M
Credentials:MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11106 BALDY MESA RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-1840
Mailing Address - Country:US
Mailing Address - Phone:818-863-0786
Mailing Address - Fax:
Practice Address - Street 1:11106 BALDY MESA RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-1840
Practice Address - Country:US
Practice Address - Phone:818-863-0786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-08
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
CA077592343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)