Healthcare Provider Details

I. General information

NPI: 1689607020
Provider Name (Legal Business Name): MAYER TENENHAUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR MAIL CODE 8890
SAN DIEGO CA
92103-9001
US

IV. Provider business mailing address

200 W ARBOR DR MAIL CODE 8890
SAN DIEGO CA
92103-9001
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-6084
  • Fax:
Mailing address:
  • Phone: 619-543-6084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA52624
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA52624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: