Provider Demographics
NPI:1750899423
Name:AHMED, ABDIRIZACK ABDULLAHI
Entity type:Individual
Prefix:
First Name:ABDIRIZACK
Middle Name:ABDULLAHI
Last Name:AHMED
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 1:13135 MESA CREST PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2249
Mailing Address - Country:US
Mailing Address - Phone:858-413-5494
Mailing Address - Fax:
Practice Address - Street 1:13135 MESA CREST PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2249
Practice Address - Country:US
Practice Address - Phone:858-413-5494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4283879OtherNON-EMERGENCY MEDICAL TRANSPORTATION