Healthcare Provider Details

I. General information

NPI: 1215949201
Provider Name (Legal Business Name): ANDREW G MAYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE #820
LA JOLLA CA
92037-1224
US

IV. Provider business mailing address

9850 GENESEE AVE #820
LA JOLLA CA
92037-1224
US

V. Phone/Fax

Practice location:
  • Phone: 858-453-5200
  • Fax: 858-453-4589
Mailing address:
  • Phone: 858-453-5200
  • Fax: 858-453-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35693
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA77759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: