Provider Demographics
NPI:1447439021
Name:FAWZI KAYALI
Entity type:Organization
Organization Name:FAWZI KAYALI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATER
Authorized Official - Prefix:MR
Authorized Official - First Name:FAWZI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-488-1980
Mailing Address - Street 1:1332 E CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-7127
Mailing Address - Country:US
Mailing Address - Phone:602-488-1980
Mailing Address - Fax:602-314-5833
Practice Address - Street 1:1332 E CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-7127
Practice Address - Country:US
Practice Address - Phone:602-488-1980
Practice Address - Fax:602-314-5833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD03788048343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ225717OtherAHCCCS