Healthcare Provider Details

I. General information

NPI: 1902267800
Provider Name (Legal Business Name): MAYA SMOLAREK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2016
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 CORDOVA ST
PASADENA CA
91101-2552
US

IV. Provider business mailing address

525 CORDOVA ST
PASADENA CA
91101-2552
US

V. Phone/Fax

Practice location:
  • Phone: 818-643-5082
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA152153
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number152153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: