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General NPI Number Information
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NPI Number | 1154430783
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Entity Type | Individual
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Provider Name | MAYER B. DAVIDSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/04/2014
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Provider Practice Location Address
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Address Line | 1760 EAST 120TH STREET MARTIN LUTHER KING OUTPATIENT CENTER.
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City | LOS ANGELES
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State | CA
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Zip | 90059-3019
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Country | US
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Telephone | 323-357-3439
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Fax |
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Provider Business Mailing Address
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Address Line | 3616 OCEAN VIEW AVE
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City | LOS ANGELES
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State | CA
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Zip | 90066-3114
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Country | US
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Telephone | 323-357-3439
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | G18264
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License Number State | CA
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