Provider Demographics
NPI:1780890699
Name:MAYA, OLGA PATRICIA (DDS)
Entity type:Individual
Prefix:DR
First Name:OLGA
Middle Name:PATRICIA
Last Name:MAYA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6248 WOODMAN AVE
Mailing Address - Street 2:APT. #07
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2959
Mailing Address - Country:US
Mailing Address - Phone:818-903-7825
Mailing Address - Fax:818-782-5868
Practice Address - Street 1:13549 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5500
Practice Address - Country:US
Practice Address - Phone:818-782-5501
Practice Address - Fax:818-782-5868
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice