Provider Demographics
NPI:1669798724
Name:NAHRA, MAYA ELIZABETH (RD)
Entity type:Individual
Prefix:MISS
First Name:MAYA
Middle Name:ELIZABETH
Last Name:NAHRA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 S VAL VISTA DR STE A3-527
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-0944
Mailing Address - Country:US
Mailing Address - Phone:216-533-4023
Mailing Address - Fax:
Practice Address - Street 1:428 S GILBERT RD STE 106-2
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-2263
Practice Address - Country:US
Practice Address - Phone:602-218-5278
Practice Address - Fax:844-218-4691
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ963735133V00000X
MO2009030631133V00000X, 133VN1004X, 133VN1005X, 133VN1006X
133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133N00000XDietary & Nutritional Service ProvidersNutritionist