Provider Demographics
NPI:1861137630
Name:DEZA, MARIA PATRICIA
Entity type:Individual
Prefix:
First Name:MARIA PATRICIA
Middle Name:
Last Name:DEZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6333
Mailing Address - Country:US
Mailing Address - Phone:352-215-7288
Mailing Address - Fax:
Practice Address - Street 1:6950 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6333
Practice Address - Country:US
Practice Address - Phone:352-215-7288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR197841363LA2200X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase Management