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General NPI Number Information
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NPI Number | 1164110995
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Entity Type | Individual
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Provider Name | MATTHEW MAIA
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Gender | Male
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Dates
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Enumeration Date | 04/28/2023
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 1000 ACCESS RD # 4
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City | PASCAGOULA
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State | MS
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Zip | 39567-4485
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Country | US
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Telephone | 228-935-3252
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Fax |
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Provider Business Mailing Address
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Address Line | 14801 LEMOYNE BLVD APT 359
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City | BILOXI
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State | MS
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Zip | 39532-7035
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Country | US
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Telephone | 228-935-3252
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 010128359
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License Number State | VA
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