Provider Demographics
NPI:1518554484
Name:GHULLAMJAILANI, AHMADJAWID
Entity Type:Individual
Prefix:
First Name:AHMADJAWID
Middle Name:
Last Name:GHULLAMJAILANI
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 1:330 KITTY HAWK RD APT 906
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3839
Mailing Address - Country:US
Mailing Address - Phone:121-088-7429
Mailing Address - Fax:
Practice Address - Street 1:9618 HUEBNER RD STE 111
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1775
Practice Address - Country:US
Practice Address - Phone:210-943-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZC0007X
TX19-108246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty