Provider Demographics
NPI:1467823963
Name:ABDALLAH, HAMZA (RRT, CRT)
Entity Type:Individual
Prefix:
First Name:HAMZA
Middle Name:
Last Name:ABDALLAH
Suffix:
Gender:M
Credentials:RRT, CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 S TEAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:92316-4147
Mailing Address - Country:US
Mailing Address - Phone:909-496-8868
Mailing Address - Fax:
Practice Address - Street 1:903 S TEAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:CA
Practice Address - Zip Code:92316-4147
Practice Address - Country:US
Practice Address - Phone:909-496-8868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF1622889343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)