Provider Demographics
NPI:1578279741
Name:ABDALLA, MOHAMED ALEHAIDEB
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ALEHAIDEB
Last Name:ABDALLA
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 1:1606 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 1:1601 W PEORIA AVE # 209
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4986
Practice Address - Country:US
Practice Address - Phone:602-427-8813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver