Provider Demographics
NPI:1093052425
Name:INTERIANO, MAIDA
Entity Type:Individual
Prefix:
First Name:MAIDA
Middle Name:
Last Name:INTERIANO
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 1:3450 THACHER RD
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-8301
Mailing Address - Country:US
Mailing Address - Phone:805-795-0429
Mailing Address - Fax:
Practice Address - Street 1:UCSB
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93106-0001
Practice Address - Country:US
Practice Address - Phone:805-893-4794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12743124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist