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General NPI Number Information
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NPI Number | 1689109696
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Entity Type | Individual
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Provider Name | MARK RYAN MAYO PSYD, CA LP 33599
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Gender | Male
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Dates
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Enumeration Date | 04/27/2017
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Last Update Date | 01/22/2023
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Provider Practice Location Address
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Address Line | 8 BERNICE ST UNIT 107
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City | SAN FRANCISCO
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State | CA
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Zip | 94103-4349
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Country | US
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Telephone | 415-489-0211
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Fax |
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Provider Business Mailing Address
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Address Line | 447 HAIGHT ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94117-3505
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Country | US
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Telephone | 415-310-4047
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 33599
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License Number State | CA
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