Provider Demographics
NPI:1548930399
Name:HAIDAR, DEAN
Entity type:Individual
Prefix:MR
First Name:DEAN
Middle Name:
Last Name:HAIDAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23511 ALISO CREEK RD APT 62
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2365
Mailing Address - Country:US
Mailing Address - Phone:703-217-2145
Mailing Address - Fax:
Practice Address - Street 1:23511 ALISO CREEK RD APT 62
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-2365
Practice Address - Country:US
Practice Address - Phone:703-217-2145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)