Healthcare Provider Details

I. General information

NPI: 1194866525
Provider Name (Legal Business Name): MAYER MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2568 CLARENDON AVE
HUNTINGTON PARK CA
90255-4073
US

IV. Provider business mailing address

2568 CLARENDON AVE
HUNTINGTON PARK CA
90255-4073
US

V. Phone/Fax

Practice location:
  • Phone: 323-582-5444
  • Fax: 323-584-6992
Mailing address:
  • Phone: 323-582-5444
  • Fax: 323-584-6992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG69356
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG69356
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG69356
License Number StateCA

VIII. Authorized Official

Name: MAYER MAYER
Title or Position: OWNER
Credential: MD
Phone: 323-582-5444