MEDICARE: DR. GEORGE MAYER MAYER ED.D., BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-99-0151	OTHER		BEHAVIOR ANALYSIS CERTIFICATION BOARD (BACB) INTERNATIONAL

General Provider Information

NPI Number	:	1477878346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE MAYER MAYER ED.D., BCBA

Provider Business Mailing Address
First Line	:	10735 FRANK DANIELS WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-2633
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10735 FRANK DANIELS WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-2633
Country	:	US
Telephone Number	:	858-549-1478
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2010
Last Update Date	:	04/02/2010

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