Provider Demographics
NPI:1093270118
Name:AMAIREH, MIKE
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:AMAIREH
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 1:1070 W ARROW HWY APT B
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4459
Mailing Address - Country:US
Mailing Address - Phone:909-605-3855
Mailing Address - Fax:
Practice Address - Street 1:1070 W ARROW HWY APT B
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4459
Practice Address - Country:US
Practice Address - Phone:909-605-3855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-02
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB8569993343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)