Jordan Mauro Maitilasso

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

10159 Mission Gorge Rd Ste C
Santee, CA 92071-3857

Phone

(619) 579-0947

Fax

(619) 588-6282

NPI assigned

Dec 31, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mental Health Systems, Inc.

  • Community/Behavioral Health Agency
  • Santee, CA
  • NPI 1609904622
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1546214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597017600000",
    "number": "1366914319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 VAN HOUTEN AVE APT J",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920205184",
            "telephone_number": "619-206-7131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10159 MISSION GORGE RD STE C",
            "city": "SANTEE",
            "state": "CA",
            "postal_code": "920713857",
            "telephone_number": "619-579-0947",
            "fax_number": "619-588-6282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAITILASSO",
        "first_name": "JORDAN",
        "middle_name": "MAURO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-31",
        "last_updated": "2020-08-10",
        "certification_date": "2020-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theresa M Lynn, M.D.
• Aleksandr Lyubasyuk, MD
• Victoria Reyes Macagba, M.D.
• Erika Sierra Macias, COTA/L
• Amro Mahmoud, DO
• Farah Makani, DPT
• Monvelea Makor
• Lyndsey Malvestuto
• Klara Cerina Ledesma Manaois
• Stephanie Manipon, FNP-BC

• Student in an Organized Health Care Education/Training Program in Santee, CA
• Providers in Santee, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.