Healthcare Provider Details

I. General information

NPI: 1780765990
Provider Name (Legal Business Name): WAYNE ROWAN MAES PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4813 CORRALES RD.
CORRALES NM
87048-0531
US

IV. Provider business mailing address

PO BOX 531
CORRALES NM
87048-0531
US

V. Phone/Fax

Practice location:
  • Phone: 505-898-5662
  • Fax: 505-898-5890
Mailing address:
  • Phone: 505-898-5662
  • Fax: 505-898-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number266
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: