Healthcare Provider Details

I. General information

NPI: 1225431299
Provider Name (Legal Business Name): TEREZA MAYA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SCOFIELD AVE
WASCO CA
93280-7515
US

IV. Provider business mailing address

2001 E 4TH ST STE 200205
SANTA ANA CA
92705-3916
US

V. Phone/Fax

Practice location:
  • Phone: 661-758-8400
  • Fax:
Mailing address:
  • Phone: 714-824-8140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95062639
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95006015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: