Healthcare Provider Details

I. General information

NPI: 1851872014
Provider Name (Legal Business Name): MAYFLOWER MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 N HOLLENBECK AVE STE 104
COVINA CA
91722-1558
US

IV. Provider business mailing address

1433 N HOLLENBECK AVE STE 104
COVINA CA
91722-1558
US

V. Phone/Fax

Practice location:
  • Phone: 626-241-2560
  • Fax: 626-214-2561
Mailing address:
  • Phone: 626-214-2560
  • Fax: 626-214-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA51499
License Number StateCA

VIII. Authorized Official

Name: ELEONOR RAMIREZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 626-331-2209