Provider Demographics
NPI:1598303877
Name:FELDMAN, MAYA (CMT, MMP)
Entity Type:Individual
Prefix:MRS
First Name:MAYA
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:CMT, MMP
Other - Prefix:MRS
Other - First Name:MAYA
Other - Middle Name:
Other - Last Name:MERKELBACH-FELDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 291269
Mailing Address - Street 2:
Mailing Address - City:PHELAN
Mailing Address - State:CA
Mailing Address - Zip Code:92329-1269
Mailing Address - Country:US
Mailing Address - Phone:760-706-8839
Mailing Address - Fax:
Practice Address - Street 1:10350 WILSON RANCH RD UNIT A
Practice Address - Street 2:
Practice Address - City:PHELAN
Practice Address - State:CA
Practice Address - Zip Code:92371-7159
Practice Address - Country:US
Practice Address - Phone:909-261-8895
Practice Address - Fax:760-281-6315
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15628225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist