Basic Information
| Provider Information | |||||||||
| NPI: | 1659331296 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEGARDA | ||||||||
| FirstName: | MARIS | ||||||||
| MiddleName: | STELLA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 480 | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939020480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8312428645 | ||||||||
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| Practice Location | |||||||||
| Address1: | 275 CROSSROADS BLVD | ||||||||
| Address2: | A | ||||||||
| City: | CARMEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939238684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317189701 | ||||||||
| FaxNumber: | 8316200304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 07/12/2013 | ||||||||
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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 | 2084N0402X | C52834 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology |
ID Information
| ID | Type | State | Issuer | Description | 6906099 | 05 | NC | MEDICAID | 96243 | 01 | SC | MEDCOST | OTHER | T30936 | 05 | SC | MEDICAID | 5004685 | 01 | SC | AETNA | OTHER |