Healthcare Provider Details

I. General information

NPI: 1710059852
Provider Name (Legal Business Name): MAYA MELLINA THONA R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W 17TH ST
SANTA ANA CA
92706-2316
US

IV. Provider business mailing address

13130 NORCIA DR
RANCHO CUCAMONGA CA
91739-9156
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-8548
  • Fax: 714-834-8372
Mailing address:
  • Phone: 909-646-9336
  • Fax: 775-637-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 563760
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberPHN 61894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: