Healthcare Provider Details

I. General information

NPI: 1093560153
Provider Name (Legal Business Name): MATEO MAYORGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 CHALLENGER DR
ALAMEDA CA
94501-1037
US

IV. Provider business mailing address

1610 63RD ST APT B
BERKELEY CA
94703-2608
US

V. Phone/Fax

Practice location:
  • Phone: 510-337-7000
  • Fax:
Mailing address:
  • Phone: 916-879-7346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: