Provider Demographics
NPI:1144586686
Name:ABDIRIZAK, FARDOWSA HASSAN
Entity type:Individual
Prefix:
First Name:FARDOWSA
Middle Name:HASSAN
Last Name:ABDIRIZAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E DUBLIN GRANVILLE RD STE 6
Mailing Address - Street 2:SUITE 6
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-4034
Mailing Address - Country:US
Mailing Address - Phone:614-805-0456
Mailing Address - Fax:
Practice Address - Street 1:3773 EMERY CLUB WAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-3162
Practice Address - Country:US
Practice Address - Phone:614-805-0456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHEPJ8001343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)