Provider Demographics
NPI:1245591676
Name:MAULDIN, DAVION
Entity type:Individual
Prefix:
First Name:DAVION
Middle Name:
Last Name:MAULDIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10221 COMPTON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WATTS
Mailing Address - State:CA
Mailing Address - Zip Code:90002-2802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10221 COMPTON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:WATTS
Practice Address - State:CA
Practice Address - Zip Code:90002-2802
Practice Address - Country:US
Practice Address - Phone:213-260-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator