Provider Demographics
NPI:1003936709
Name:MACCUISH, JAMES A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:MACCUISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1941 HUNTINGTON DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4967
Mailing Address - Country:US
Mailing Address - Phone:626-799-5450
Mailing Address - Fax:626-799-2507
Practice Address - Street 1:1941 HUNTINGTON DR
Practice Address - Street 2:SUITE E
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4967
Practice Address - Country:US
Practice Address - Phone:626-799-5450
Practice Address - Fax:626-799-2507
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23295174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist