Provider Demographics
NPI:1003650474
Name:JUMAAH, ODAI
Entity type:Individual
Prefix:
First Name:ODAI
Middle Name:
Last Name:JUMAAH
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 1:7490 OPPORTUNITY RD STE 2600
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2232
Mailing Address - Country:US
Mailing Address - Phone:619-558-6653
Mailing Address - Fax:
Practice Address - Street 1:7490 OPPORTUNITY RD STE 2600
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2232
Practice Address - Country:US
Practice Address - Phone:619-558-6653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver