Provider Demographics
NPI:1669994166
Name:MERSAL, MAYA
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:MERSAL
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 1:3011 SE 142ND PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-2612
Mailing Address - Country:US
Mailing Address - Phone:503-702-0178
Mailing Address - Fax:
Practice Address - Street 1:316 SE 123RD AVE STE A67
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4056
Practice Address - Country:US
Practice Address - Phone:503-702-0178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist