Provider Demographics
NPI:1942853338
Name:ABDALLA, BUTHAINA
Entity Type:Individual
Prefix:
First Name:BUTHAINA
Middle Name:
Last Name:ABDALLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NW 110TH AVE APT 410
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6944
Mailing Address - Country:US
Mailing Address - Phone:754-707-3618
Mailing Address - Fax:954-835-0448
Practice Address - Street 1:1400 NW 110TH AVE APT 410
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-6944
Practice Address - Country:US
Practice Address - Phone:754-707-3618
Practice Address - Fax:954-835-0448
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)