Provider Demographics
NPI:1609351485
Name:JAMA, AHMED ABDI (OWNER)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:ABDI
Last Name:JAMA
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 XENIA ST APT 109
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3588
Mailing Address - Country:US
Mailing Address - Phone:614-787-3326
Mailing Address - Fax:
Practice Address - Street 1:1313 XENIA ST APT 109
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3588
Practice Address - Country:US
Practice Address - Phone:614-787-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO123244172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver