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NPI Code Detail

MEDICARE: MICHAEL MAYORGA

MEDICARE: MICHAEL MAYORGA
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1871325944
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL MAYORGA
Provider Business Mailing Address
First Line : 1821 1/2 S SYCAMORE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90019-5340
Country : US
Telephone Number : 310-266-1151
Fax Number :
Provider Business Practice Location Address
First Line : 5628 E SLAUSON AVE
Second Line :
City : COMMERCE
State : CA
Zip : 90040-2922
Country : US
Telephone Number : 323-318-9960
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2024
Last Update Date : 04/14/2026

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Directions to “ MICHAEL MAYORGA ” Practice Location

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