Healthcare Provider Details

I. General information

NPI: 1194353631
Provider Name (Legal Business Name): MAYA FIRSOWICZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8860 CENTER DR STE 300
LA MESA CA
91942-7001
US

IV. Provider business mailing address

8860 CENTER DR STE 300
LA MESA CA
91942-7001
US

V. Phone/Fax

Practice location:
  • Phone: 619-462-1670
  • Fax: 619-462-3209
Mailing address:
  • Phone: 619-462-1670
  • Fax: 619-462-3209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA195623
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: