Provider Demographics
NPI:1982360046
Name:ALHELOW, MAYSA ISSAM
Entity Type:Individual
Prefix:MR
First Name:MAYSA
Middle Name:ISSAM
Last Name:ALHELOW
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 1:9614 MOONROCK WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-4855
Mailing Address - Country:US
Mailing Address - Phone:661-371-0094
Mailing Address - Fax:661-412-4439
Practice Address - Street 1:9614 MOONROCK WAY
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-4855
Practice Address - Country:US
Practice Address - Phone:661-371-0094
Practice Address - Fax:661-412-4439
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1090Other1090
CA1090Medicaid