Provider Demographics
NPI:1801334123
Name:MAYA, JACQUELINE CELINA
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CELINA
Last Name:MAYA
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 1:2360 MIDDLEBURY WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-2766
Mailing Address - Country:US
Mailing Address - Phone:209-603-4186
Mailing Address - Fax:
Practice Address - Street 1:2360 MIDDLEBURY WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-2766
Practice Address - Country:US
Practice Address - Phone:209-603-4186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician