Provider Demographics
NPI:1710616081
Name:MAWLEY, AJINKYA
Entity Type:Individual
Prefix:
First Name:AJINKYA
Middle Name:
Last Name:MAWLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23520 CACTUS AVE # B2013
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-8906
Mailing Address - Country:US
Mailing Address - Phone:951-867-3825
Mailing Address - Fax:951-955-5511
Practice Address - Street 1:23520 CACTUS AVE # B2013
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-8906
Practice Address - Country:US
Practice Address - Phone:951-867-3825
Practice Address - Fax:951-955-5511
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program