MEDICARE: MAYA GOMEZ MAILHOT

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1477363984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA GOMEZ MAILHOT

Provider Business Mailing Address
First Line	:	952 14TH AVE SW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55902-2078
Country	:	US
Telephone Number	:	612-516-2693
Fax Number	:

Provider Business Practice Location Address
First Line	:	952 14TH AVE SW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55902-2078
Country	:	US
Telephone Number	:	612-516-2693
Fax Number	:

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

Provider Enumeration Date	:	01/08/2025
Last Update Date	:	01/12/2026

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