Healthcare Provider Details

I. General information

NPI: 1417861717
Provider Name (Legal Business Name): MAYRA GORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E ALOSTA AVE
AZUSA CA
91702-2701
US

IV. Provider business mailing address

901 E ALOSTA AVE
AZUSA CA
91702-2701
US

V. Phone/Fax

Practice location:
  • Phone: 714-351-5605
  • Fax:
Mailing address:
  • Phone: 626-815-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberRN95348844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: