Provider Demographics
NPI:1114037645
Name:DOYLE, MARY (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DOYLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:DOYLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9320 TELSTAR AVENUE
Mailing Address - Street 2:SUITE 226, ROOM 246
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731
Mailing Address - Country:US
Mailing Address - Phone:626-569-6484
Mailing Address - Fax:626-569-9346
Practice Address - Street 1:9320 TELSTAR AVE
Practice Address - Street 2:SUITE 226
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2834
Practice Address - Country:US
Practice Address - Phone:626-569-6484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56282208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics