Provider Demographics
NPI:1629257563
Name:FADLELMULA, SAMI A (TRANSPORTAITION)
Entity Type:Individual
Prefix:
First Name:SAMI
Middle Name:A
Last Name:FADLELMULA
Suffix:
Gender:M
Credentials:TRANSPORTAITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 W SURREY AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-1974
Mailing Address - Country:US
Mailing Address - Phone:602-435-4443
Mailing Address - Fax:602-439-2268
Practice Address - Street 1:4201 W SURREY AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-1974
Practice Address - Country:US
Practice Address - Phone:602-435-4443
Practice Address - Fax:602-439-2268
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-28
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ115387343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)