Provider Demographics
NPI:1568935138
Name:MOHAMED, ABDURAHMAN AIDARUS
Entity Type:Individual
Prefix:
First Name:ABDURAHMAN
Middle Name:AIDARUS
Last Name:MOHAMED
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 1:4631 62ND ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4003
Mailing Address - Country:US
Mailing Address - Phone:917-214-7505
Mailing Address - Fax:
Practice Address - Street 1:4631 62ND ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4003
Practice Address - Country:US
Practice Address - Phone:917-214-7505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)