Healthcare Provider Details

I. General information

NPI: 1720993629
Provider Name (Legal Business Name): ANDRE MAYFIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1936 S AMERICAN ST
STOCKTON CA
95206-2726
US

IV. Provider business mailing address

2639 SILVA ST
STOCKTON CA
95205-7754
US

V. Phone/Fax

Practice location:
  • Phone: 209-463-3622
  • Fax:
Mailing address:
  • Phone: 209-670-3680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: