Provider Demographics
NPI:1952824195
Name:MAYA NAIR MD LLC
Entity Type:Organization
Organization Name:MAYA NAIR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:NAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-488-6678
Mailing Address - Street 1:PO BOX 11499
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-0499
Mailing Address - Country:US
Mailing Address - Phone:503-488-6678
Mailing Address - Fax:503-200-1168
Practice Address - Street 1:835 SE STEPHENS ST STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4636
Practice Address - Country:US
Practice Address - Phone:503-488-6678
Practice Address - Fax:503-200-1168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD177956261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health