Provider Demographics
NPI:1760988687
Name:RIAZ, NATISHA CHANEL (TAXI/MEDICAL TRANSPO)
Entity Type:Individual
Prefix:MRS
First Name:NATISHA
Middle Name:CHANEL
Last Name:RIAZ
Suffix:
Gender:F
Credentials:TAXI/MEDICAL TRANSPO
Other - Prefix:MRS
Other - First Name:NATISHA
Other - Middle Name:CHANEL
Other - Last Name:RIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BLAIRS TRANS CO LLC
Mailing Address - Street 1:181 BLAIRS CT LOT 51
Mailing Address - Street 2:
Mailing Address - City:BLAIRS
Mailing Address - State:VA
Mailing Address - Zip Code:24527-2305
Mailing Address - Country:US
Mailing Address - Phone:434-709-4262
Mailing Address - Fax:434-608-0501
Practice Address - Street 1:181 BLAIRS CT LOT 51
Practice Address - Street 2:
Practice Address - City:BLAIRS
Practice Address - State:VA
Practice Address - Zip Code:24527-2305
Practice Address - Country:US
Practice Address - Phone:434-709-4262
Practice Address - Fax:434-771-0001
Is Sole Proprietor?:No
Enumeration Date:2018-03-31
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH111088172A00000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1760988687Medicaid