Provider Demographics
NPI:1215347299
Name:MAYA DIAGNOSTIC IMAGING, LLC
Entity type:Organization
Organization Name:MAYA DIAGNOSTIC IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:SAPP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-342-5842
Mailing Address - Street 1:3241 HIDDEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5427
Mailing Address - Country:US
Mailing Address - Phone:407-342-5842
Mailing Address - Fax:
Practice Address - Street 1:294 PATTERSON RD STE B
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-6263
Practice Address - Country:US
Practice Address - Phone:863-438-7465
Practice Address - Fax:863-438-7466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology