Provider Demographics
NPI:1346714375
Name:MHAISSEN, MAHA
Entity type:Individual
Prefix:
First Name:MAHA
Middle Name:
Last Name:MHAISSEN
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 1:2272 E PRESTWICK AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-5958
Mailing Address - Country:US
Mailing Address - Phone:901-495-0606
Mailing Address - Fax:
Practice Address - Street 1:2272 E PRESTWICK AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93730-5958
Practice Address - Country:US
Practice Address - Phone:901-495-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-12
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist