1477136794 NPI number — DR. JUSTINE ANDREA MAHER MD, MPH

Table of content: DR. JUSTINE ANDREA MAHER MD, MPH (NPI 1477136794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477136794 NPI number — DR. JUSTINE ANDREA MAHER MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHER
Provider First Name:
JUSTINE
Provider Middle Name:
ANDREA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477136794
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UCI RESIDENCY OFFICE
Provider Second Line Business Mailing Address:
333 CITY BLVD WEST, SUITE 1400
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-869-0831
Provider Business Mailing Address Fax Number:
714-456-8360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UCI MEDICAL CENTER
Provider Second Line Business Practice Location Address:
101 THE CITY DRIVE SOUTH
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-880-7812
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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