Healthcare Provider Details

I. General information

NPI: 1093052425
Provider Name (Legal Business Name): MAIDA INTERIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCSB
SANTA BARBARA CA
93106-0001
US

IV. Provider business mailing address

3450 THACHER RD
OJAI CA
93023-8301
US

V. Phone/Fax

Practice location:
  • Phone: 805-893-4794
  • Fax:
Mailing address:
  • Phone: 805-795-0429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number12743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: