Provider Demographics
NPI:1457522583
Name:BALLAHO, MUSTAPHA KHEMAR (RPSGT)
Entity Type:Individual
Prefix:
First Name:MUSTAPHA
Middle Name:KHEMAR
Last Name:BALLAHO
Suffix:
Gender:M
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7560 CHARMANT DR
Mailing Address - Street 2:APT. # 1539
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5058
Mailing Address - Country:US
Mailing Address - Phone:818-206-6249
Mailing Address - Fax:
Practice Address - Street 1:7560 CHARMANT DR
Practice Address - Street 2:APT. # 1539
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-5058
Practice Address - Country:US
Practice Address - Phone:818-206-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic