Basic Information
| Provider Information | |||||||||
| NPI: | 1659548204 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATHEW | ||||||||
| FirstName: | MAYA | ||||||||
| MiddleName: | MARY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 MASSELIN AVE | ||||||||
| Address2: | #423 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900365763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233565816 | ||||||||
| FaxNumber: | 5049883971 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 WILSHIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900172395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2139772121 | ||||||||
| FaxNumber: | 2132027028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2008 | ||||||||
| LastUpdateDate: | 04/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A113265 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | A113265 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.