Healthcare Provider Details

I. General information

NPI: 1477138311
Provider Name (Legal Business Name): MARIANNA MAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 S MILITARY TRL STE 103
DELRAY BEACH FL
33484-2600
US

IV. Provider business mailing address

14000 S MILITARY TRL STE 103
DELRAY BEACH FL
33484-2600
US

V. Phone/Fax

Practice location:
  • Phone: 561-819-0620
  • Fax:
Mailing address:
  • Phone: 561-819-0620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: