Provider Demographics
NPI:1295186765
Name:THIES, MARIA (DO)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:THIES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41120 WASHINGTON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-9596
Mailing Address - Country:US
Mailing Address - Phone:760-360-3193
Mailing Address - Fax:760-360-3194
Practice Address - Street 1:41120 WASHINGTON ST STE 201
Practice Address - Street 2:
Practice Address - City:BERMUDA DUNES
Practice Address - State:CA
Practice Address - Zip Code:92203-9596
Practice Address - Country:US
Practice Address - Phone:760-360-3193
Practice Address - Fax:760-360-3194
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5701022763207R00000X
CA20A17345207R00000X
MI5101025109207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine