Healthcare Provider Details

I. General information

NPI: 1952824195
Provider Name (Legal Business Name): MAYA NAIR MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 SE STEPHENS ST STE 201
PORTLAND OR
97214-4636
US

IV. Provider business mailing address

PO BOX 11499
PORTLAND OR
97211-0499
US

V. Phone/Fax

Practice location:
  • Phone: 503-488-6678
  • Fax: 503-200-1168
Mailing address:
  • Phone: 503-488-6678
  • Fax: 503-200-1168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMD177956
License Number StateOR

VIII. Authorized Official

Name: MAYA LEIGH NAIR
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 503-488-6678