Provider Demographics
NPI:1760159370
Name:MAENZA, JOSEPH GAETANO
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GAETANO
Last Name:MAENZA
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 1:13020 ROMILEY CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6995
Mailing Address - Country:US
Mailing Address - Phone:314-315-1317
Mailing Address - Fax:
Practice Address - Street 1:13020 ROMILEY CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6995
Practice Address - Country:US
Practice Address - Phone:314-315-1317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program