Provider Demographics
NPI:1699979047
Name:ABDI, MOHAMED
Entity type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:
Last Name:ABDI
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 1:951 E CARLA VISTA PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8801
Mailing Address - Country:US
Mailing Address - Phone:480-776-9439
Mailing Address - Fax:
Practice Address - Street 1:951 E CARLA VISTA PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8801
Practice Address - Country:US
Practice Address - Phone:480-776-9439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDO4329901344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi