Provider Demographics
NPI:1215499850
Name:GUIDI, MAHOULOME HAROLD
Entity type:Individual
Prefix:
First Name:MAHOULOME
Middle Name:HAROLD
Last Name:GUIDI
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 1:12121 E MISSION AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4832
Mailing Address - Country:US
Mailing Address - Phone:509-280-7164
Mailing Address - Fax:
Practice Address - Street 1:12121 E MISSION AVE STE C
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4832
Practice Address - Country:US
Practice Address - Phone:509-280-7164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
311ZA0620X
WA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies