Provider Demographics
NPI:1164848701
Name:BAUER, MAYA WOLPERT (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYA
Middle Name:WOLPERT
Last Name:BAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAYA
Other - Middle Name:NINA
Other - Last Name:WOLPERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:501 J ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-2325
Mailing Address - Country:US
Mailing Address - Phone:916-497-3247
Mailing Address - Fax:
Practice Address - Street 1:2516 STOCKTON BLVD
Practice Address - Street 2:UC DAVIS DEPARTMENT OF PEDIATRICS
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2208
Practice Address - Country:US
Practice Address - Phone:916-734-3665
Practice Address - Fax:916-734-0342
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA154007208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program