Provider Demographics
NPI:1104405737
Name:MAXIMOUS, MARIANA NABIL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:NABIL
Last Name:MAXIMOUS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2246 NEWPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-6743
Mailing Address - Country:US
Mailing Address - Phone:949-646-7744
Mailing Address - Fax:949-646-4614
Practice Address - Street 1:2246 NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-6743
Practice Address - Country:US
Practice Address - Phone:949-646-7744
Practice Address - Fax:949-646-4614
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA589701835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist