Healthcare Provider Details

I. General information

NPI: 1073937751
Provider Name (Legal Business Name): DR. MARIA GONZALEZ-MAYO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2014
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N FLOWER ST
SANTA ANA CA
92703-2361
US

IV. Provider business mailing address

1013 MAERTZWEILER DR
PLACENTIA CA
92870-5291
US

V. Phone/Fax

Practice location:
  • Phone: 714-647-4148
  • Fax:
Mailing address:
  • Phone: 714-647-4148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number45865
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: