Provider Demographics
NPI:1861016917
Name:MAYES, LAKESHA
Entity Type:Individual
Prefix:
First Name:LAKESHA
Middle Name:
Last Name:MAYES
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 1:28577 BAUVARDIA WAY
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-7436
Mailing Address - Country:US
Mailing Address - Phone:619-940-8487
Mailing Address - Fax:
Practice Address - Street 1:1845 CHICAGO AVE STE B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2366
Practice Address - Country:US
Practice Address - Phone:951-465-3664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program