Provider Demographics
NPI:1750049904
Name:ATTAOUI, YASSINE
Entity Type:Individual
Prefix:
First Name:YASSINE
Middle Name:
Last Name:ATTAOUI
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 1:3543 NW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-2825
Mailing Address - Country:US
Mailing Address - Phone:612-356-1257
Mailing Address - Fax:612-400-7593
Practice Address - Street 1:3543 NW 22ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-2825
Practice Address - Country:US
Practice Address - Phone:612-356-1257
Practice Address - Fax:612-400-7593
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1912718937343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)