Provider Demographics
NPI:1598128977
Name:MAEZ, MICHAEL
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:MAEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:MAEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MEDICAL ASSISTANT
Mailing Address - Street 1:1174 24TH STREET
Mailing Address - Street 2:APT 4
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401
Mailing Address - Country:US
Mailing Address - Phone:435-225-3526
Mailing Address - Fax:
Practice Address - Street 1:1174 24TH ST
Practice Address - Street 2:APT 4
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-2763
Practice Address - Country:US
Practice Address - Phone:435-225-3526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility