MEDICARE: ABDULAHI ADE NOOR

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
1	343900000X	Non-emergency Medical Transport (VAN)		CA

General Provider Information

NPI Number	:	1639731292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABDULAHI ADE NOOR

Provider Business Mailing Address
First Line	:	3077 39TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-4012
Country	:	US
Telephone Number	:	619-855-1228
Fax Number	:	619-229-1178

Provider Business Practice Location Address
First Line	:	3077 39TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-4012
Country	:	US
Telephone Number	:	619-855-1228
Fax Number	:	619-229-1178

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2019
Last Update Date	:	07/03/2019

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