Healthcare Provider Details

I. General information

NPI: 1396076998
Provider Name (Legal Business Name): MICHAEL THOMAS MAIO C.E.S.,C.P.T.,C.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10999 SORRENTO VALLEY RD
SAN DIEGO CA
92121-1612
US

IV. Provider business mailing address

10999 SORRENTO VALLEY RD
SAN DIEGO CA
92121-1612
US

V. Phone/Fax

Practice location:
  • Phone: 858-792-7600
  • Fax:
Mailing address:
  • Phone: 858-792-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: