Provider Demographics
NPI:1811390263
Name:MIKHAEL, HAIDY
Entity Type:Individual
Prefix:
First Name:HAIDY
Middle Name:
Last Name:MIKHAEL
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 1:6602 LEANNE ST
Mailing Address - Street 2:
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752-3478
Mailing Address - Country:US
Mailing Address - Phone:909-261-5360
Mailing Address - Fax:
Practice Address - Street 1:6602 LEANNE ST
Practice Address - Street 2:
Practice Address - City:MIRA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91752-3478
Practice Address - Country:US
Practice Address - Phone:909-261-5360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program