Healthcare Provider Details

I. General information

NPI: 1609018514
Provider Name (Legal Business Name): YVETTE MAEZ M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20325 N 51ST AVE STE 168
GLENDALE AZ
85308-4624
US

IV. Provider business mailing address

2414 W OLD PAINT TRL
PHOENIX AZ
85086-6608
US

V. Phone/Fax

Practice location:
  • Phone: 480-219-3075
  • Fax: 480-264-5747
Mailing address:
  • Phone: 844-385-3747
  • Fax: 480-462-2801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2413
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: