Provider Demographics
NPI:1417169897
Name:RICCI, MAYA K (FNP)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:K
Last Name:RICCI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WILLOW PLZ
Mailing Address - Street 2:201
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6206
Mailing Address - Country:US
Mailing Address - Phone:559-627-9284
Mailing Address - Fax:559-713-0965
Practice Address - Street 1:100 WILLOW PLZ
Practice Address - Street 2:201
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6206
Practice Address - Country:US
Practice Address - Phone:559-627-9284
Practice Address - Fax:559-713-0965
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4333207VH0002X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0067850Medicaid
CAZZZ47930ZMedicare ID - Type Unspecified