Provider Demographics
NPI:1629342589
Name:RAHAL, MUSA RAHAL
Entity Type:Individual
Prefix:MR
First Name:MUSA
Middle Name:RAHAL
Last Name:RAHAL
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 1:1116 S 11TH AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701-3323
Mailing Address - Country:US
Mailing Address - Phone:520-409-5435
Mailing Address - Fax:
Practice Address - Street 1:1116 S 11TH AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-3323
Practice Address - Country:US
Practice Address - Phone:520-409-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3020443343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZINOLES27-28419748Medicare PIN