Provider Demographics
NPI:1326296435
Name:YAP, MAUREEN BANZUELA (OD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:BANZUELA
Last Name:YAP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:BANZUELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2700 COLORADO BLVD
Mailing Address - Street 2:SUITE 239
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1081
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 COLORADO BLVD
Practice Address - Street 2:SUITE 239
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1081
Practice Address - Country:US
Practice Address - Phone:888-769-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV-007333-1152W00000X
AZ1798152W00000X
CA14562152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist