Provider Demographics
NPI:1487896742
Name:HABBANI, ELFADIL MAWIA
Entity type:Individual
Prefix:MR
First Name:ELFADIL
Middle Name:MAWIA
Last Name:HABBANI
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 1:4027 1/2 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2619
Mailing Address - Country:US
Mailing Address - Phone:619-381-1900
Mailing Address - Fax:
Practice Address - Street 1:4027 1/2 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2619
Practice Address - Country:US
Practice Address - Phone:619-381-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle