MEDICARE: YASIN ABDULLATIF KAWALYA CNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343800000X	Secured Medical Transport (VAN)	S32771310	MA

General Provider Information

NPI Number	:	1073165676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASIN ABDULLATIF KAWALYA CNA

Provider Business Mailing Address
First Line	:	42 FERRY LN
Second Line	:
City	:	LOWELL
State	:	MA
Zip	:	01850-1936
Country	:	US
Telephone Number	:	978-328-2641
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 FERRY LN
Second Line	:
City	:	LOWELL
State	:	MA
Zip	:	01850-1936
Country	:	US
Telephone Number	:	978-328-2641
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2019
Last Update Date	:	07/13/2019

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