Provider Demographics
NPI:1932178456
Name:VAZIRANI, MAYA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYA
Middle Name:M
Last Name:VAZIRANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 W AVENUE J
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2703
Mailing Address - Country:US
Mailing Address - Phone:661-945-6717
Mailing Address - Fax:661-945-6718
Practice Address - Street 1:1717 W AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2703
Practice Address - Country:US
Practice Address - Phone:661-945-6717
Practice Address - Fax:661-945-6718
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33369208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN96036OtherBLUE CROSS OF CA MEDI-CAL
953804947OtherTAX ID
CA00A333690Medicaid
VA0101029195OtherPHYSICIAN &SURGEON
CAA33369OtherPHYSICIAN & SURGEON LICEN