Healthcare Provider Details

I. General information

NPI: 1619666922
Provider Name (Legal Business Name): AMMAR A OBAIDALLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W GROVE PKWY APT 1077
TEMPE AZ
85283-4523
US

IV. Provider business mailing address

900 W GROVE PKWY APT 1077
TEMPE AZ
85283-4523
US

V. Phone/Fax

Practice location:
  • Phone: 602-478-4737
  • Fax:
Mailing address:
  • Phone: 602-478-4737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: