MEDICARE: IVAN DARIO MAYA 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	207RN0300X	Nephrology Physician	ME107626	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730111527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVAN DARIO MAYA MD

Provider Business Mailing Address
First Line	:	807 S ORLANDO AVE
Second Line	:	SUITE C
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4870
Country	:	US
Telephone Number	:	407-515-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	766 N SUN DR
Second Line	:	SUITE 3030
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2552
Country	:	US
Telephone Number	:	407-444-2800
Fax Number	:

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	05/06/2024

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