Provider Demographics
NPI:1962023440
Name:GARCIA MAYA, RAUL FERNANDO (MD)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:FERNANDO
Last Name:GARCIA MAYA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6041
Mailing Address - Country:US
Mailing Address - Phone:480-834-9039
Mailing Address - Fax:480-964-7802
Practice Address - Street 1:1828 E FLORENCE BLVD
Practice Address - Street 2:BLDG C, STE 142
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4783
Practice Address - Country:US
Practice Address - Phone:480-834-9039
Practice Address - Fax:520-876-5261
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ75280207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program