Provider Demographics
NPI:1942826219
Name:OMER, ASHRAF ALI SR
Entity Type:Individual
Prefix:
First Name:ASHRAF
Middle Name:ALI
Last Name:OMER
Suffix:SR
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 1:19820 N 13TH AVE UNIT 147
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4310
Mailing Address - Country:US
Mailing Address - Phone:480-703-6105
Mailing Address - Fax:
Practice Address - Street 1:19820 N 13TH AVE UNIT 147
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4310
Practice Address - Country:US
Practice Address - Phone:480-703-6105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ654175343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)