Provider Demographics
NPI:1215691126
Name:ALZARKANI, ALAA M SR
Entity type:Individual
Prefix:MR
First Name:ALAA
Middle Name:M
Last Name:ALZARKANI
Suffix:SR
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 1:12818 15TH PL W
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204
Mailing Address - Country:US
Mailing Address - Phone:425-345-2691
Mailing Address - Fax:
Practice Address - Street 1:311 W ARMSTRONG AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-4103
Practice Address - Country:US
Practice Address - Phone:425-345-2691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
83-1023775OtherNON-MEDICAL TRANSPORTATION