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NPI Code Detail

MEDICARE: ERNESTO MAYORGA MAYORGA LCSW

MEDICARE: ERNESTO MAYORGA MAYORGA LCSW
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
11041C0700XClinical Social Worker106945CA

General Provider Information

NPI Number : 1861952087
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERNESTO MAYORGA MAYORGA LCSW
Provider Business Mailing Address
First Line : PO BOX 690313
Second Line :
City : STOCKTON
State : CA
Zip : 95269-0313
Country : US
Telephone Number : 916-874-1975
Fax Number :
Provider Business Practice Location Address
First Line : 12500 BRUCEVILLE RD
Second Line :
City : ELK GROVE
State : CA
Zip : 95757-9784
Country : US
Telephone Number : 916-874-1927
Fax Number : 916-854-8911
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2019
Last Update Date : 12/17/2025

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Directions to “ ERNESTO MAYORGA MAYORGA LCSW” Practice Location

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