Provider Demographics
NPI:1497296222
Name:MAPLETHORPE, MARIA REGINA
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:REGINA
Last Name:MAPLETHORPE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:REGINA
Other - Last Name:SISON-VALENTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9216 N HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-2120
Mailing Address - Country:US
Mailing Address - Phone:541-915-0876
Mailing Address - Fax:541-349-9226
Practice Address - Street 1:1904 NE DIVISION ST.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1146
Practice Address - Country:US
Practice Address - Phone:503-517-8663
Practice Address - Fax:503-943-4994
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW1597175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW1597OtherTRADITIONAL HEALTH WORKER