Provider Demographics
NPI:1548958275
Name:ABDOUN, ELMOIZ ISMAIL
Entity type:Individual
Prefix:
First Name:ELMOIZ
Middle Name:ISMAIL
Last Name:ABDOUN
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 1:6901 S MCCLINTOCK DR APT 159
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4181
Mailing Address - Country:US
Mailing Address - Phone:602-419-0888
Mailing Address - Fax:
Practice Address - Street 1:6901 S MCCLINTOCK DR APT 159
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-4181
Practice Address - Country:US
Practice Address - Phone:602-419-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)