Healthcare Provider Details

I. General information

NPI: 1790167609
Provider Name (Legal Business Name): ABBO TRANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6444 N 67TH AVE APT 2108
GLENDALE AZ
85301-4385
US

IV. Provider business mailing address

6444 N 67TH AVE APT 2108
GLENDALE AZ
85301-4385
US

V. Phone/Fax

Practice location:
  • Phone: 623-703-2988
  • Fax:
Mailing address:
  • Phone: 623-703-2988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number000000
License Number StateAZ

VIII. Authorized Official

Name: ELTAHIR ABBO
Title or Position: OWNER
Credential:
Phone: 623-703-2988