Healthcare Provider Details

I. General information

NPI: 1609655745
Provider Name (Legal Business Name): MAYA CHEEK RADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 MAIN ST
MORRO BAY CA
93442-1552
US

IV. Provider business mailing address

2460 MAIN ST
MORRO BAY CA
93442-1552
US

V. Phone/Fax

Practice location:
  • Phone: 805-772-2212
  • Fax:
Mailing address:
  • Phone: 805-772-2212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License NumberR1516510723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: