Provider Demographics
NPI:1356773360
Name:AL KURAISHI, MAYCE (MD)
Entity type:Individual
Prefix:DR
First Name:MAYCE
Middle Name:
Last Name:AL KURAISHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 FLYNN RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5092
Mailing Address - Country:US
Mailing Address - Phone:805-659-1740
Mailing Address - Fax:805-659-3217
Practice Address - Street 1:500 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2607
Practice Address - Country:US
Practice Address - Phone:805-933-0895
Practice Address - Fax:805-933-3836
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA142349208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics