Provider Demographics
NPI:1750036166
Name:ALSOUBAII, AHMED
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:ALSOUBAII
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 1:3016 W BOWKER ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-3524
Mailing Address - Country:US
Mailing Address - Phone:602-500-5442
Mailing Address - Fax:
Practice Address - Street 1:3016 W BOWKER ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-3524
Practice Address - Country:US
Practice Address - Phone:602-500-5442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver