Provider Demographics
NPI:1295206969
Name:MEHROTRA, MAYA
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:MEHROTRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 LAS ESTRELLAS CT
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-4070
Mailing Address - Country:US
Mailing Address - Phone:805-236-4428
Mailing Address - Fax:
Practice Address - Street 1:2009 LAS ESTRELLAS CT
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-4070
Practice Address - Country:US
Practice Address - Phone:805-236-4428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician