Healthcare Provider Details

I. General information

NPI: 1659331296
Provider Name (Legal Business Name): MARIS STELLA LEGARDA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23845 HOLMAN HWY STE 210
MONTEREY CA
93940-5907
US

IV. Provider business mailing address

100 WILSON RD STE 100
MONTEREY CA
93940-7885
US

V. Phone/Fax

Practice location:
  • Phone: 831-620-0700
  • Fax: 831-620-0304
Mailing address:
  • Phone: 831-242-8645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberC52834
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberC52834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: