Healthcare Provider Details

I. General information

NPI: 1932178456
Provider Name (Legal Business Name): MAYA M VAZIRANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W AVENUE J
LANCASTER CA
93534-2703
US

IV. Provider business mailing address

1717 W AVENUE J
LANCASTER CA
93534-2703
US

V. Phone/Fax

Practice location:
  • Phone: 661-945-6717
  • Fax: 661-945-6718
Mailing address:
  • Phone: 661-945-6717
  • Fax: 661-945-6718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA33369
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA33369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: