Healthcare Provider Details

I. General information

NPI: 1003188160
Provider Name (Legal Business Name): MAYFLOWER MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N ORANGE AVE. SUITE 100
WEST COVINA CA
91790-2032
US

IV. Provider business mailing address

140 N ORANGE AVE STE 100
WEST COVINA CA
91790-2032
US

V. Phone/Fax

Practice location:
  • Phone: 626-800-1200
  • Fax: 626-962-2471
Mailing address:
  • Phone: 626-800-1200
  • Fax: 626-962-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ERICA CARBAJAL
Title or Position: SITE MANAGER
Credential:
Phone: 626-800-1200