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General NPI Number Information
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NPI Number | 1720993629
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Entity Type | Individual
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Provider Name | ANDRE MAYFIELD
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Gender | Male
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Dates
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Enumeration Date | 08/17/2026
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Last Update Date | 08/17/2026
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Provider Practice Location Address
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Address Line | 1936 S AMERICAN ST
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City | STOCKTON
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State | CA
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Zip | 95206-2726
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Country | US
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Telephone | 209-463-3622
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Fax |
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Provider Business Mailing Address
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Address Line | 2639 SILVA ST
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City | STOCKTON
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State | CA
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Zip | 95205-7754
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Country | US
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Telephone | 209-670-3680
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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 | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State | CA
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