Provider Demographics
NPI:1477363984
Name:MAILHOT, MAYA GOMEZ
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:GOMEZ
Last Name:MAILHOT
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 1:952 14TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-2078
Mailing Address - Country:US
Mailing Address - Phone:612-516-2693
Mailing Address - Fax:
Practice Address - Street 1:952 14TH AVE SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-2078
Practice Address - Country:US
Practice Address - Phone:612-516-2693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty