Provider Demographics
NPI:1477705580
Name:MAYA, ANTONIO EDUARDO (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:EDUARDO
Last Name:MAYA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N MACLAY AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-2959
Mailing Address - Country:US
Mailing Address - Phone:818-898-1000
Mailing Address - Fax:818-898-1010
Practice Address - Street 1:321 N MACLAY AVE
Practice Address - Street 2:UNIT C
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-2970
Practice Address - Country:US
Practice Address - Phone:818-723-1963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 30976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor