Provider Demographics
NPI:1609513050
Name:BAHRAMI, HABIBULLAH
Entity Type:Individual
Prefix:
First Name:HABIBULLAH
Middle Name:
Last Name:BAHRAMI
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 1:5501 DE MARCUS BLVD APT 239
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-7458
Mailing Address - Country:US
Mailing Address - Phone:765-702-9917
Mailing Address - Fax:
Practice Address - Street 1:5501 DE MARCUS BLVD APT 239
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-7458
Practice Address - Country:US
Practice Address - Phone:765-702-9917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)