Healthcare Provider Details

I. General information

NPI: 1114620515
Provider Name (Legal Business Name): OLA MAYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 03/24/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E MARKET ST
WARREN OH
44483-6608
US

IV. Provider business mailing address

1350 E MARKET ST
WARREN OH
44483-6608
US

V. Phone/Fax

Practice location:
  • Phone: 330-675-5714
  • Fax: 330-675-5721
Mailing address:
  • Phone: 330-675-5706
  • Fax: 330-675-5720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: