Healthcare Provider Details

I. General information

NPI: 1962935940
Provider Name (Legal Business Name): MAYO HOTTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 12/03/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4733 W SUNSET BLVD FL 3
LOS ANGELES CA
90027-6021
US

IV. Provider business mailing address

4733 W SUNSET BLVD FL 3
LOS ANGELES CA
90027-6021
US

V. Phone/Fax

Practice location:
  • Phone: 310-923-0789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: