Provider Demographics
NPI:1245788348
Name:CLAYTON, MAYA (LVN)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15251 SENECA RD APT 64
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-6528
Mailing Address - Country:US
Mailing Address - Phone:337-400-6145
Mailing Address - Fax:
Practice Address - Street 1:15251 SENECA RD APT 64
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-6528
Practice Address - Country:US
Practice Address - Phone:337-400-6145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-17
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN215434164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse