Individual
MOUFOUTAHO LIASSOU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
59 IONA ST, PROVIDENCE, RI 02908-2307
(401) 601-5857
Mailing address
59 IONA ST, PROVIDENCE, RI 02908-2307
(401) 601-5857
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
PMV-302
RI
Other
Enumeration date
06/25/2013
Last updated
07/29/2013
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