Provider Demographics
NPI:1285068676
Name:EISSA-ASAAD, MAISAA A (CT)
Entity type:Individual
Prefix:
First Name:MAISAA
Middle Name:A
Last Name:EISSA-ASAAD
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 WINTERWIND CIR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-5242
Mailing Address - Country:US
Mailing Address - Phone:314-308-0055
Mailing Address - Fax:
Practice Address - Street 1:337 WINTERWIND CIR
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5242
Practice Address - Country:US
Practice Address - Phone:314-308-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLM1309246QC2700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QC2700XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyCytotechnology