Provider Demographics
NPI:1194866525
Name:MAYER MD INC
Entity Type:Organization
Organization Name:MAYER MD INC
Other - Org Name:DR. MAYER'S WOMEN'S AND CHILDREN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-582-5444
Mailing Address - Street 1:2568 CLARENDON AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4073
Mailing Address - Country:US
Mailing Address - Phone:323-582-5444
Mailing Address - Fax:323-584-6992
Practice Address - Street 1:2568 CLARENDON AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4073
Practice Address - Country:US
Practice Address - Phone:323-582-5444
Practice Address - Fax:323-584-6992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69356207Q00000X, 207V00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0095862OtherMEDI-CAL NUMBER
CAF77328Medicare UPIN
CAG69356Medicare ID - Type UnspecifiedMEDICARE NUMBER