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General NPI Number Information
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NPI Number | 1386904019
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Entity Type | Organization
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Legal Business Name | MZ TRANS
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Dates
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Enumeration Date | 05/29/2012
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Last Update Date | 08/27/2012
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Provider Practice Location Address
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Address Line | 8603 N 22ND AVE APT 134
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City | PHOENIX
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State | AZ
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Zip | 85021
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Country | US
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Telephone | 480-286-9779
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Fax |
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Provider Business Mailing Address
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Address Line | 8603 N 22ND AVE #134
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City | PHOENIX
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State | AZ
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Zip | 85021-4262
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Country | US
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Telephone | 480-286-9779
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | IBRAHIM E AHMED
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Credential | OWNER
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Telephone | 480-286-9779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 547418
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License Number State | AZ
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