Provider Demographics
NPI:1598278905
Name:ABDUL, ABDI H
Entity Type:Individual
Prefix:
First Name:ABDI
Middle Name:H
Last Name:ABDUL
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 1:4265 FAIRMOUNT AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-6404
Mailing Address - Country:US
Mailing Address - Phone:619-866-1421
Mailing Address - Fax:
Practice Address - Street 1:4265 FAIRMOUNT AVE STE 180
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-6404
Practice Address - Country:US
Practice Address - Phone:619-866-1421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205OtherNON-EMERGENCY MEDICAL TRANSPORTATION