Provider Demographics
NPI:1497030258
Name:MOTTA, MAYRA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:
Last Name:MOTTA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BALINT DR APT 645
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-3958
Mailing Address - Country:US
Mailing Address - Phone:646-546-9850
Mailing Address - Fax:
Practice Address - Street 1:11 BALINT DR APT 645
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-3958
Practice Address - Country:US
Practice Address - Phone:646-546-9850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298617-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse