Provider Demographics
NPI:1780063164
Name:AL-TIMIMI, ABDULRAZAQ
Entity type:Individual
Prefix:
First Name:ABDULRAZAQ
Middle Name:
Last Name:AL-TIMIMI
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 1:1182 SUMNER AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-4865
Mailing Address - Country:US
Mailing Address - Phone:619-992-0250
Mailing Address - Fax:
Practice Address - Street 1:1182 SUMNER AVE APT 8
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4865
Practice Address - Country:US
Practice Address - Phone:619-992-0250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB7945860343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)