Healthcare Provider Details

I. General information

NPI: 1801914577
Provider Name (Legal Business Name): ANGELITA MAEZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGIE MAEZ PH.D

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 VIA LUCERO APT 12
SANTA BARBARA CA
93110-1648
US

IV. Provider business mailing address

3960 VIA LUCERO APT 12
SANTA BARBARA CA
93110-1648
US

V. Phone/Fax

Practice location:
  • Phone: 805-569-3139
  • Fax: 805-988-2240
Mailing address:
  • Phone: 805-569-3139
  • Fax: 805-988-2240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberPSY12363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: