Healthcare Provider Details

I. General information

NPI: 1013739689
Provider Name (Legal Business Name): MAYAN MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W 6TH ST STE 3
LOS ANGELES CA
90057-3139
US

IV. Provider business mailing address

11827 ROSE AVE
LOS ANGELES CA
90066-1119
US

V. Phone/Fax

Practice location:
  • Phone: 213-483-9996
  • Fax:
Mailing address:
  • Phone: 310-707-7768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARLOS F MONTOYA SR.
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 310-707-7768