Provider Demographics
NPI:1821627696
Name:MAYMONE, MAYRA B C (MD)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:B C
Last Name:MAYMONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAYRA
Other - Middle Name:
Other - Last Name:BUAINAIN DE CASTRO MAYMONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12631 E 17TH AVE RM 5403
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2527
Mailing Address - Country:US
Mailing Address - Phone:303-724-2680
Mailing Address - Fax:
Practice Address - Street 1:660 BANNOCK ST STE 5135
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4506
Practice Address - Country:US
Practice Address - Phone:303-436-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0072871207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology