Provider Demographics
NPI:1174716559
Name:THANGAVELU, MAYA (PHD)
Entity type:Individual
Prefix:DR
First Name:MAYA
Middle Name:
Last Name:THANGAVELU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 TOWN AND COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4716
Mailing Address - Country:US
Mailing Address - Phone:800-745-4363
Mailing Address - Fax:714-245-9257
Practice Address - Street 1:1054 TOWN AND COUNTRY RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4716
Practice Address - Country:US
Practice Address - Phone:800-745-4363
Practice Address - Fax:714-245-9257
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADRM8207SC0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics