Provider Demographics
NPI:1003607938
Name:WASEEM, TAYYAB
Entity type:Individual
Prefix:
First Name:TAYYAB
Middle Name:
Last Name:WASEEM
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 1:9610 MILAN DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-3514
Mailing Address - Country:US
Mailing Address - Phone:516-524-9764
Mailing Address - Fax:
Practice Address - Street 1:9610 MILAN DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-3514
Practice Address - Country:US
Practice Address - Phone:516-524-9764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW9174882344600000X, 343900000X, 344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Yes344600000XTransportation ServicesTaxi