Provider Demographics
NPI:1326394222
Name:LAYABAN, MAXIMINA
Entity Type:Individual
Prefix:
First Name:MAXIMINA
Middle Name:
Last Name:LAYABAN
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 1:5125 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-5200
Mailing Address - Country:US
Mailing Address - Phone:916-955-4000
Mailing Address - Fax:916-965-4506
Practice Address - Street 1:5125 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-5200
Practice Address - Country:US
Practice Address - Phone:916-955-4000
Practice Address - Fax:916-965-4506
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-28
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347003311311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home