Provider Demographics
NPI:1366695439
Name:EVANS, MAYA CAPOOR (MD)
Entity type:Individual
Prefix:DR
First Name:MAYA
Middle Name:CAPOOR
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAYA
Other - Middle Name:
Other - Last Name:CAPOOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-7041
Mailing Address - Fax:916-734-7838
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:SUITE 1700
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-7041
Practice Address - Fax:916-734-7838
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55452202081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI68086 0873Medicaid
WI1366695439Medicaid
WI68086 0873Medicaid