Provider Demographics
NPI:1912863705
Name:INGRAHAM, MAISHA JANE
Entity type:Individual
Prefix:
First Name:MAISHA
Middle Name:JANE
Last Name:INGRAHAM
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 1:3100 PARK AVE APT 15317
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-3731
Mailing Address - Country:US
Mailing Address - Phone:714-863-3848
Mailing Address - Fax:
Practice Address - Street 1:3100 PARK AVE APT 15317
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-3731
Practice Address - Country:US
Practice Address - Phone:714-863-3848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-24
Last Update Date:2025-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician