Provider Demographics
NPI:1952766842
Name:ALI, MOHAMED ABDIRAZAK
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ABDIRAZAK
Last Name:ALI
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 1:12535 W KALER DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85307-1786
Mailing Address - Country:US
Mailing Address - Phone:602-531-7461
Mailing Address - Fax:
Practice Address - Street 1:1102 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3107
Practice Address - Country:US
Practice Address - Phone:602-273-7000
Practice Address - Fax:602-273-7003
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)