Provider Demographics
NPI:1689423402
Name:TOTAH, KHALIL N
Entity type:Individual
Prefix:MR
First Name:KHALIL
Middle Name:N
Last Name:TOTAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5037 FOXBORO DR
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-1416
Mailing Address - Country:US
Mailing Address - Phone:510-330-8640
Mailing Address - Fax:
Practice Address - Street 1:5037 FOXBORO DR
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-1416
Practice Address - Country:US
Practice Address - Phone:510-330-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)