Provider Demographics
NPI:1386877678
Name:HASSAN, KHALID MUTWAKIL
Entity type:Individual
Prefix:MR
First Name:KHALID
Middle Name:MUTWAKIL
Last Name:HASSAN
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 1:1710 S JENTILLY LN
Mailing Address - Street 2:APT 3
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5750
Mailing Address - Country:US
Mailing Address - Phone:602-348-5754
Mailing Address - Fax:602-606-7932
Practice Address - Street 1:1710 S JENTILLY LN
Practice Address - Street 2:APT 3
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5750
Practice Address - Country:US
Practice Address - Phone:602-348-5754
Practice Address - Fax:602-606-7932
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ443829343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ443829OtherMEDICAL TRANSPORTATION PROVIDER NUMBER