MEDICARE: ABDOLAZEZ ABDOLQADER

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1912750274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABDOLAZEZ ABDOLQADER

Provider Business Mailing Address
First Line	:	2862 VICTORIAN RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1572
Country	:	US
Telephone Number	:	702-439-4962
Fax Number	:

Provider Business Practice Location Address
First Line	:	2862 VICTORIAN RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1572
Country	:	US
Telephone Number	:	702-439-4962
Fax Number	:

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

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	04/10/2024

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