Provider Demographics
NPI:1922850783
Name:JAMA, ABDIAZIZ MOHAMED
Entity Type:Individual
Prefix:
First Name:ABDIAZIZ
Middle Name:MOHAMED
Last Name:JAMA
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 1:6850 MEADOWBROOK BLVD APT 413
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-4629
Mailing Address - Country:US
Mailing Address - Phone:206-504-0269
Mailing Address - Fax:
Practice Address - Street 1:1919 BROADWAY ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1251
Practice Address - Country:US
Practice Address - Phone:612-323-1871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician