Provider Demographics
NPI:1992445712
Name:MIQDADY, TAHER I
Entity type:Individual
Prefix:MR
First Name:TAHER
Middle Name:
Last Name:MIQDADY
Suffix:I
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 1:11762 DE PALMA RD
Mailing Address - Street 2:SUITE 1-C PMB 474
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883
Mailing Address - Country:US
Mailing Address - Phone:714-814-0994
Mailing Address - Fax:
Practice Address - Street 1:11762 DE PALMA RD
Practice Address - Street 2:SUITE 1-C PMB 474
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883
Practice Address - Country:US
Practice Address - Phone:714-814-0994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)