Basic Information
| Provider Information | |||||||||
| NPI: | 1649438763 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAMMAS | ||||||||
| FirstName: | MAYA | ||||||||
| MiddleName: | CHRISTINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3510 MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | |||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902622010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106389391 | ||||||||
| FaxNumber: | 3106038749 | ||||||||
| Practice Location | |||||||||
| Address1: | 3510 MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | |||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902622010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106389391 | ||||||||
| FaxNumber: | 3106038749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2008 | ||||||||
| LastUpdateDate: | 08/09/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 245279 | NY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207W00000X | A113118 | CA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | A113118 | 01 | CA | LICENSE | OTHER |