Provider Demographics
NPI:1346683042
Name:WESS, MAURICE MONYA
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:MONYA
Last Name:WESS
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 1:3220 SHADOW SPRINGS PL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1768
Mailing Address - Country:US
Mailing Address - Phone:601-310-8492
Mailing Address - Fax:
Practice Address - Street 1:1 PERIMETER PARK S
Practice Address - Street 2:SUITE 100 N
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2327
Practice Address - Country:US
Practice Address - Phone:205-234-5843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMONYA8492253Z00000X
AL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1346683042Medicaid