Healthcare Provider Details

I. General information

NPI: 1114295417
Provider Name (Legal Business Name): MACER MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 DEEP VALLEY DR SUITE 207
ROLLING HILLS ESTATES CA
90274-3647
US

IV. Provider business mailing address

PO BOX 3098
TORRANCE CA
90510-3098
US

V. Phone/Fax

Practice location:
  • Phone: 310-541-8400
  • Fax: 310-541-7900
Mailing address:
  • Phone: 310-792-3914
  • Fax: 855-898-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG67152
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG42123
License Number StateCA

VIII. Authorized Official

Name: CYNTHIA MACER
Title or Position: PRESIDENT/ OWNER
Credential: MD
Phone: 310-541-8400