Healthcare Provider Details

I. General information

NPI: 1417651746
Provider Name (Legal Business Name): NICOLE PAIGE MAYNARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 W CHAPMAN AVE STE 500
ORANGE CA
92868-1638
US

IV. Provider business mailing address

3800 W CHAPMAN AVE STE 500
ORANGE CA
92868-1638
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5902
  • Fax:
Mailing address:
  • Phone: 714-456-5770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA199476
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: