Provider Demographics
NPI:1033580212
Name:BAGBY, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BAGBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 HIGHLAND DR STE 106D
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2409
Mailing Address - Country:US
Mailing Address - Phone:858-668-8366
Mailing Address - Fax:
Practice Address - Street 1:990 HIGHLAND DR STE 106D
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2409
Practice Address - Country:US
Practice Address - Phone:858-668-8366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2015-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2355A2700X
CA130107208174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant