Provider Demographics
NPI:1386424794
Name:MAIZE, ERIC JASON
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JASON
Last Name:MAIZE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8618 ADRIAN AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-1100
Mailing Address - Country:US
Mailing Address - Phone:818-429-6717
Mailing Address - Fax:
Practice Address - Street 1:8618 ADRIAN AVE
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-1100
Practice Address - Country:US
Practice Address - Phone:818-429-6717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies