Healthcare Provider Details

I. General information

NPI: 1689824849
Provider Name (Legal Business Name): CYNTHIA LYNN MAYER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 TORRANCE BLVD LITTLE COMPANY OF MARY HOSPITAL
TORRANCE CA
90503-4698
US

IV. Provider business mailing address

PO BOX 3065
SOUTH PASADENA CA
91031
US

V. Phone/Fax

Practice location:
  • Phone: 310-303-5764
  • Fax: 310-303-5520
Mailing address:
  • Phone: 602-740-7749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number204 7301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: