Basic Information
| Provider Information | |||||||||
| NPI: | 1992985279 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOUSTON | ||||||||
| FirstName: | MAYA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 ALHAMBRA CT | ||||||||
| Address2: | |||||||||
| City: | ANTIOCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945091914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252345619 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2311 LOVERIDGE RD | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945655117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254312600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2007 | ||||||||
| LastUpdateDate: | 07/02/2019 | ||||||||
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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 | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.