Healthcare Provider Details

I. General information

NPI: 1386785715
Provider Name (Legal Business Name): RALPH MAYER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13309 VAN NUYS BLVD
PACOIMA CA
91331-3006
US

IV. Provider business mailing address

2700 S FIGUEROA ST A
LOS ANGELES CA
90007-3255
US

V. Phone/Fax

Practice location:
  • Phone: 818-899-0069
  • Fax: 818-896-4899
Mailing address:
  • Phone: 213-743-9050
  • Fax: 213-747-7768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG69356
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG69356
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG69356
License Number StateCA

VIII. Authorized Official

Name: RALPH MAYER
Title or Position: OWNER
Credential: M.D.
Phone: 213-743-9050