Healthcare Provider Details

I. General information

NPI: 1265082713
Provider Name (Legal Business Name): MAYO HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 SEPULVEDA BLVD
TORRANCE CA
90505-2803
US

IV. Provider business mailing address

2820 SEPULVEDA BLVD
TORRANCE CA
90505-2803
US

V. Phone/Fax

Practice location:
  • Phone: 310-325-8500
  • Fax:
Mailing address:
  • Phone: 310-325-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. VICTORIA H CHO
Title or Position: PRESIDENT
Credential: L.AC.
Phone: 310-776-0554