Provider Demographics
NPI:1780399790
Name:ALDAWOOD, BILAL M
Entity type:Individual
Prefix:
First Name:BILAL
Middle Name:M
Last Name:ALDAWOOD
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 1:8430 PINE RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-7233
Mailing Address - Country:US
Mailing Address - Phone:916-620-4020
Mailing Address - Fax:
Practice Address - Street 1:8430 PINE RIVER WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-7233
Practice Address - Country:US
Practice Address - Phone:916-620-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY3575074OtherNEMT