Healthcare Provider Details

I. General information

NPI: 1356773360
Provider Name (Legal Business Name): MAYCE AL KURAISHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E MAIN ST
SANTA PAULA CA
93060-2607
US

IV. Provider business mailing address

1040 FLYNN RD
CAMARILLO CA
93012-5092
US

V. Phone/Fax

Practice location:
  • Phone: 805-933-0895
  • Fax: 805-933-3836
Mailing address:
  • Phone: 805-659-1740
  • Fax: 805-659-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA142349
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: