Provider Demographics
NPI:1437592433
Name:MAYA MEDICAL SERVICES
Entity Type:Organization
Organization Name:MAYA MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IME
Authorized Official - Middle Name:
Authorized Official - Last Name:OKON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-249-9070
Mailing Address - Street 1:2908 W. CAMELBACK RD.
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017
Mailing Address - Country:US
Mailing Address - Phone:602-249-9070
Mailing Address - Fax:602-249-9165
Practice Address - Street 1:2908 W. CAMELBACK RD.
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017
Practice Address - Country:US
Practice Address - Phone:602-249-9070
Practice Address - Fax:602-249-9165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care