Provider Demographics
NPI:1184825754
Name:MAYA, NOSSA WALID (MD)
Entity Type:Individual
Prefix:DR
First Name:NOSSA
Middle Name:WALID
Last Name:MAYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EINAS
Other - Middle Name:WALID
Other - Last Name:SHAKIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:671 S MOLLISON AVE STE B&C
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-6682
Mailing Address - Country:US
Mailing Address - Phone:619-455-0122
Mailing Address - Fax:
Practice Address - Street 1:671 S MOLLISON AVE STE B&C
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-6682
Practice Address - Country:US
Practice Address - Phone:619-455-0122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine