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NPI Code Detail

MEDICARE: MARY ANN FLAVAN MD

MEDICARE: MARY ANN FLAVAN MD
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
12084F0202XForensic Psychiatry PhysicianC33843CA
22084P0800XPsychiatry PhysicianC33843CA

General Provider Information

NPI Number : 1740232990
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ANN FLAVAN MD
Provider Business Mailing Address
First Line : 2890 ATASCADERO RD
Second Line :
City : MORRO BAY
State : CA
Zip : 93442-1869
Country : US
Telephone Number : 805-712-6161
Fax Number : 805-357-5999
Provider Business Practice Location Address
First Line : 520 E TULARE AVE
Second Line :
City : VISALIA
State : CA
Zip : 93292-3629
Country : US
Telephone Number : 559-623-0900
Fax Number : 559-733-6861
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 02/27/2014

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