Provider Demographics
NPI:1124206891
Name:CAJULIS, MARIA KAY (DME SUPPLIER)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:KAY
Last Name:CAJULIS
Suffix:
Gender:F
Credentials:DME SUPPLIER
Other - Prefix:
Other - First Name:VISITING
Other - Middle Name:ANGELS
Other - Last Name:PATIENT CARE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2954 HONOLULU AVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3909
Mailing Address - Country:US
Mailing Address - Phone:818-249-5007
Mailing Address - Fax:818-279-2285
Practice Address - Street 1:2954 HONOLULU AVE
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3909
Practice Address - Country:US
Practice Address - Phone:818-249-5007
Practice Address - Fax:818-279-2285
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6627630001OtherPTAN, ALSO CALLED NSC PROVIDER NUMBER