Provider Demographics
NPI:1750846887
Name:ENAD, MCWAYNE MASKARINO
Entity Type:Individual
Prefix:
First Name:MCWAYNE
Middle Name:MASKARINO
Last Name:ENAD
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 1:2045 DE ANZA LN
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-5437
Mailing Address - Country:US
Mailing Address - Phone:415-290-2644
Mailing Address - Fax:
Practice Address - Street 1:2045 DE ANZA LN
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-5437
Practice Address - Country:US
Practice Address - Phone:415-290-2644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-03
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26651227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered