Healthcare Provider Details

I. General information

NPI: 1669944807
Provider Name (Legal Business Name): RAYMOND BAHAKEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 CYPRESS CREEK AVE E
TUSCALOOSA AL
35405-4417
US

IV. Provider business mailing address

4501 CYPRESS CREEK AVE E
TUSCALOOSA AL
35405-4417
US

V. Phone/Fax

Practice location:
  • Phone: 205-556-5466
  • Fax:
Mailing address:
  • Phone: 205-556-5466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND BAHAKEL
Title or Position: OWNER
Credential:
Phone: 205-556-5466