Provider Demographics
NPI:1700175676
Name:AWADALLA, ALMAHAL
Entity Type:Individual
Prefix:
First Name:ALMAHAL
Middle Name:
Last Name:AWADALLA
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 1:1868 E BROADWAY RD
Mailing Address - Street 2:APT 510
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1641
Mailing Address - Country:US
Mailing Address - Phone:480-570-6264
Mailing Address - Fax:
Practice Address - Street 1:1868 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1641
Practice Address - Country:US
Practice Address - Phone:480-570-6264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ512800343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)