Healthcare Provider Details

I. General information

NPI: 1215691126
Provider Name (Legal Business Name): MR. ALAA M ALZARKANI SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 01/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W ARMSTRONG AVE
PEORIA IL
61604-4103
US

IV. Provider business mailing address

12818 15TH PL W
EVERETT WA
98204
US

V. Phone/Fax

Practice location:
  • Phone: 425-345-2691
  • Fax:
Mailing address:
  • Phone: 425-345-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier83-1023775
Identifier TypeOTHER
Identifier State
Identifier IssuerNON-MEDICAL TRANSPORTATION

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: