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Organization
BLUE YE MAYA LLC
Active
Organization
BLUE YE MAYA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELL LUTTRELL (OWNER)
(602) 246-4466
Entity
Organization
Contact information
Practice address
531 E LYNWOOD ST FL 2, PHOENIX, AZ 85004-1626
(602) 821-1594
Mailing address
531 E LYNWOOD ST FL 2, PHOENIX, AZ 85004-1626
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
NULL
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Enumeration date
04/09/2018
Last updated
09/18/2018
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