Provider Demographics
NPI:1144588344
Name:MAIAVA, AIMEE HERNANDEZ (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:HERNANDEZ
Last Name:MAIAVA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15272 SUMMIT AVE
Mailing Address - Street 2:T1958
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0231
Mailing Address - Country:US
Mailing Address - Phone:909-646-7194
Mailing Address - Fax:909-689-4196
Practice Address - Street 1:15272 SUMMIT AVE
Practice Address - Street 2:T1958
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-0231
Practice Address - Country:US
Practice Address - Phone:909-646-7194
Practice Address - Fax:909-689-4196
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist