Provider Demographics
NPI:1639862824
Name:MAYA, MARILYN
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:MAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-2947
Mailing Address - Country:US
Mailing Address - Phone:863-242-3724
Mailing Address - Fax:
Practice Address - Street 1:1121 AVENUE L
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-2947
Practice Address - Country:US
Practice Address - Phone:863-242-3724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service