Provider Demographics
NPI:1467898973
Name:ELHAG, AMIN ELRAYAH
Entity Type:Individual
Prefix:MR
First Name:AMIN
Middle Name:ELRAYAH
Last Name:ELHAG
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 1:630 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-3720
Mailing Address - Country:US
Mailing Address - Phone:480-326-2165
Mailing Address - Fax:
Practice Address - Street 1:630 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-3720
Practice Address - Country:US
Practice Address - Phone:480-326-2165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-12
Last Update Date:2013-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ900928659172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver