Basic Information
| Provider Information | |||||||||
| NPI: | 1225431299 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAYA | ||||||||
| FirstName: | TEREZA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 E 4TH ST STE 200205 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927053916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148248140 | ||||||||
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| Practice Location | |||||||||
| Address1: | 701 SCOFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | WASCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932807515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617588400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2014 | ||||||||
| LastUpdateDate: | 09/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 95062639 | CA | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | 95006015 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.