Provider Demographics
NPI:1639731292
Name:NOOR, ABDULAHI ADE
Entity Type:Individual
Prefix:
First Name:ABDULAHI
Middle Name:ADE
Last Name:NOOR
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 1:3077 39TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-4012
Mailing Address - Country:US
Mailing Address - Phone:619-855-1228
Mailing Address - Fax:619-229-1178
Practice Address - Street 1:3077 39TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-4012
Practice Address - Country:US
Practice Address - Phone:619-855-1228
Practice Address - Fax:619-229-1178
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)