Provider Demographics
NPI:1548985062
Name:TASSEW, RIDVAN
Entity type:Individual
Prefix:MISS
First Name:RIDVAN
Middle Name:
Last Name:TASSEW
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 1:7995 EAST MISSISSIPPI AVENUE APP J6
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-2042
Mailing Address - Country:US
Mailing Address - Phone:720-641-5618
Mailing Address - Fax:
Practice Address - Street 1:7995 EAST MISSISSIPPI AVENUE APP J6
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-2042
Practice Address - Country:US
Practice Address - Phone:720-641-5618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No172A00000XOther Service ProvidersDriver