Doctor Name: | DR. MAYA ALYCE PETTIES |
NPI Number: | 1104057140 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D. |
License Number: | 20918 |
Business Practice Address: | 3102 E. Highland Ave Medical Staff Office Patton, CA - 92369 |
Business Phone Number: | 9094257679 |
Business Fax Number: | 9094256635 |
Mailing Address: | 3102 E. Highland Avenue, Medical Staff Office PATTON |
State: | CA |
Postal Code: | 92369 |
Phone Number: | 9094257679 |
Fax Number: | 9094256635 |
NPI Enumeration Date: | 08/06/2009 |
NPI Last Update Date: | 11/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 20918 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |