Provider Demographics
NPI:1619304979
Name:DOCTOR MAYA CLINIC INC.
Entity Type:Organization
Organization Name:DOCTOR MAYA CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SARKISYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:800-590-6292
Mailing Address - Street 1:5301 N FEDERAL HWY
Mailing Address - Street 2:200
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-4917
Mailing Address - Country:US
Mailing Address - Phone:800-590-6292
Mailing Address - Fax:
Practice Address - Street 1:5301 N FEDERAL HWY
Practice Address - Street 2:200
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-4917
Practice Address - Country:US
Practice Address - Phone:800-590-6292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2662171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty