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NPI Code Detail

MEDICARE: IMAN AL SUDANI

MEDICARE: IMAN AL SUDANI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1245735851
Entity Type Code : Individual
Provider Name (Legal Business Name) : IMAN AL SUDANI
Provider Business Mailing Address
First Line : 3450 LOST LAKE PL UNIT H4
Second Line :
City : FORT COLLINS
State : CO
Zip : 80528-7055
Country : US
Telephone Number : 970-294-4129
Fax Number :
Provider Business Practice Location Address
First Line : 1613 PROSPECT PARK WAY STE 110
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-9707
Country : US
Telephone Number : 970-377-9401
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2018
Last Update Date : 03/26/2018

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Directions to “ IMAN AL SUDANI ” Practice Location

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