Healthcare Provider Details
I. General information
NPI: 1407198880
Provider Name (Legal Business Name): MAYA P. HEATH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 03/23/2013
Last Update Date: 08/25/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
7777 FOREST LN
DALLAS TX
75230-2571
US
IV. Provider business mailing address
1121 E SPRING CREEK PKWY. STE. 110, 319
PLANO TX
75074
US
V. Phone/Fax
- Phone: 214-343-6663
- Fax: 214-343-2814
- Phone: 214-343-6663
- Fax: 214-343-2814
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2080N0001X |
| Taxonomy | Neonatal-Perinatal Medicine Physician |
| License Number | 301125 |
| License Number State | LA |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2080N0001X |
| Taxonomy | Neonatal-Perinatal Medicine Physician |
| License Number | S1121 |
| License Number State | TX |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: