Provider Demographics
NPI:1073165676
Name:KAWALYA, YASIN ABDULLATIF (CNA)
Entity Type:Individual
Prefix:
First Name:YASIN
Middle Name:ABDULLATIF
Last Name:KAWALYA
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 FERRY LN
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01850-1936
Mailing Address - Country:US
Mailing Address - Phone:978-328-2641
Mailing Address - Fax:
Practice Address - Street 1:42 FERRY LN
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01850-1936
Practice Address - Country:US
Practice Address - Phone:978-328-2641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-13
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS32771310343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)