Healthcare Provider Details

I. General information

NPI: 1043536378
Provider Name (Legal Business Name): LAURA BETH MAYER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RONALD REAGAN UCLA MEDICAL CENTER757
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

8911 ANN CROSS DR
GARDEN GROVE CA
92841-4604
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-8655
  • Fax:
Mailing address:
  • Phone: 714-251-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA119623
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: