Provider Demographics
NPI:1780120253
Name:MAYA NATURAL HEALTH CLINIC, LLC
Entity type:Organization
Organization Name:MAYA NATURAL HEALTH CLINIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MATEOS
Authorized Official - Suffix:
Authorized Official - Credentials:BCDHH
Authorized Official - Phone:801-377-0009
Mailing Address - Street 1:315 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-4747
Mailing Address - Country:US
Mailing Address - Phone:801-377-0009
Mailing Address - Fax:801-691-0799
Practice Address - Street 1:315 N STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4747
Practice Address - Country:US
Practice Address - Phone:801-377-0009
Practice Address - Fax:801-691-0799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5153374-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty