Healthcare Provider Details

I. General information

NPI: 1770666828
Provider Name (Legal Business Name): ENDOCRINE CONSULTANTS AND SPECIALISTS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA SUITE 420
ORANGE CA
92868
US

IV. Provider business mailing address

1140 W LA VETA STE 420
ORANGE CA
92868
US

V. Phone/Fax

Practice location:
  • Phone: 714-285-1904
  • Fax: 714-571-5979
Mailing address:
  • Phone: 714-285-1904
  • Fax: 714-571-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMUEL O MAYEDA
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 714-285-1904