Individual
ANDRIA CYMONE MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
205 PASADENA AVE, SOUTH PASADENA, CA 91030-2919
(323) 344-5538
Mailing address
205 PASADENA AVE, SOUTH PASADENA, CA 91030-2919
(323) 344-5538
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
131376
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7184
MEDI-CAL
CA
01
—
7368
MEDI-CAL
CA
01
—
7667
MEDI-CAL
CA
01
—
7708
MEDI-CAL
CA
Enumeration date
05/09/2022
Last updated
10/03/2024
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