Provider Demographics
NPI:1235707183
Name:MAYTA, LEE ANNE (LVN)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ANNE
Last Name:MAYTA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12138 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-8823
Mailing Address - Country:US
Mailing Address - Phone:530-588-6381
Mailing Address - Fax:
Practice Address - Street 1:12138 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-8823
Practice Address - Country:US
Practice Address - Phone:530-588-6381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN704389164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse