=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003188160
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAYFLOWER MEDICAL GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2012
-----------------------------------------------------
Last Update Date | 10/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 N ORANGE AVE. SUITE 100
-----------------------------------------------------
City | WEST COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91790-2032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-800-1200
-----------------------------------------------------
Fax | 626-962-2471
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 N ORANGE AVE STE 100
-----------------------------------------------------
City | WEST COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91790-2032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-800-1200
-----------------------------------------------------
Fax | 626-962-2471
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SITE MANAGER
-----------------------------------------------------
Name | ERICA CARBAJAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-800-1200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------