=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093052425
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAIDA INTERIANO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2013
-----------------------------------------------------
Last Update Date | 01/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | UCSB
-----------------------------------------------------
City | SANTA BARBARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93106-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-893-4794
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3450 THACHER RD
-----------------------------------------------------
City | OJAI
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93023-8301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-795-0429
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 12743
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------