Provider Demographics
NPI:1619666922
Name:OBAIDALLA, AMMAR A
Entity Type:Individual
Prefix:
First Name:AMMAR
Middle Name:A
Last Name:OBAIDALLA
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 1:900 W GROVE PKWY APT 1077
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4523
Mailing Address - Country:US
Mailing Address - Phone:602-478-4737
Mailing Address - Fax:
Practice Address - Street 1:900 W GROVE PKWY APT 1077
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-4523
Practice Address - Country:US
Practice Address - Phone:602-478-4737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company