Provider Demographics
NPI:1154885978
Name:PASHALIEV, KRASIMIR IVANOV
Entity type:Individual
Prefix:
First Name:KRASIMIR
Middle Name:IVANOV
Last Name:PASHALIEV
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 1:247 BENT ARROW DR
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2551
Mailing Address - Country:US
Mailing Address - Phone:850-368-9890
Mailing Address - Fax:
Practice Address - Street 1:109 MELVIN ST
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2338
Practice Address - Country:US
Practice Address - Phone:850-368-9890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP241-509-77-214-0343900000X, 344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)