Individual provider · NPI-1

Maya Miko Botomani-Mposi, PA-C

Physician Assistant · Grand Prairie, TX

NPI number1558094029
StatusActive
Last updated in NPPESMar 24, 2025

Details

NPI
1558094029
Entity type
Individual (NPI-1)
Name
Ms. Maya Miko Botomani-Mposi
Credential
PA-C
Sex
Female
Sole proprietor
Yes
Enumeration date
Jul 2, 2022
Certification date
Mar 24, 2025
Last updated
Mar 24, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363A00000X Physician AssistantPA18300TXYes

Practice location

7560 Waterpoint St
Grand Prairie, TX 75054-0170

Phone 817-917-0516

Mailing address

7560 Waterpoint St
Grand Prairie, TX 75054-0170

Phone 817-917-0516

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