Provider Demographics
NPI:1225859978
Name:DIOUM, AISHA CHANTEL MAYFIELD
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:CHANTEL MAYFIELD
Last Name:DIOUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AISHA
Other - Middle Name:C
Other - Last Name:MAYFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2910 W 77TH ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-1012
Mailing Address - Country:US
Mailing Address - Phone:424-541-0899
Mailing Address - Fax:
Practice Address - Street 1:2910 W 77TH ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-1012
Practice Address - Country:US
Practice Address - Phone:424-541-0899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter