MEDICARE: DR. LATOYA ELSA NADIA MAYNARD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	P8158	TX
2	207P00000X	Emergency Medicine Physician	A92833	CA

General Provider Information

NPI Number	:	1396823795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LATOYA ELSA NADIA MAYNARD MD

Provider Business Mailing Address
First Line	:	1255 N POST OAK RD APT 7206
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-7331
Country	:	US
Telephone Number	:	832-607-4026
Fax Number	:

Provider Business Practice Location Address
First Line	:	13338 TOMBALL PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77086-3129
Country	:	US
Telephone Number	:	346-907-5550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	04/18/2018

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