Provider Demographics
NPI:1518663665
Name:NOBIAN LLC
Entity Type:Organization
Organization Name:NOBIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-427-8813
Mailing Address - Street 1:1606 W PEORIA AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5710
Mailing Address - Country:US
Mailing Address - Phone:602-427-8813
Mailing Address - Fax:
Practice Address - Street 1:1606 W PEORIA AVE APT 209
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5710
Practice Address - Country:US
Practice Address - Phone:602-427-8813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ999998Medicaid