Provider Demographics
NPI:1598360547
Name:MYSAYSANA, AIRA
Entity Type:Individual
Prefix:MRS
First Name:AIRA
Middle Name:
Last Name:MYSAYSANA
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 1:7448 ELDER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95824-4311
Mailing Address - Country:US
Mailing Address - Phone:916-915-4545
Mailing Address - Fax:916-400-4192
Practice Address - Street 1:7448 ELDER CREEK RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95824-4311
Practice Address - Country:US
Practice Address - Phone:916-915-4545
Practice Address - Fax:916-400-4192
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver