Basic Information
| Provider Information | |||||||||
| NPI: | 1356773360 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AL KURAISHI | ||||||||
| FirstName: | MAYCE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 FLYNN RD | ||||||||
| Address2: | |||||||||
| City: | CAMARILLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930125092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056591740 | ||||||||
| FaxNumber: | 8056593217 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SANTA PAULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930602607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059330895 | ||||||||
| FaxNumber: | 8059333836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2013 | ||||||||
| LastUpdateDate: | 04/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A142349 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.