Provider Demographics
NPI:1780984849
Name:SALIH, YAAGOUB EISA II (YS)
Entity type:Individual
Prefix:MR
First Name:YAAGOUB
Middle Name:EISA
Last Name:SALIH
Suffix:II
Gender:M
Credentials:YS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 E GAYLON DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2719
Mailing Address - Country:US
Mailing Address - Phone:480-255-8817
Mailing Address - Fax:
Practice Address - Street 1:1750 E GAYLON DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2719
Practice Address - Country:US
Practice Address - Phone:480-255-8817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD02291055343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ534465Medicaid