Provider Demographics
NPI:1205011251
Name:MAYO, DAVID (CAS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MAYO
Suffix:
Gender:M
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-2748
Mailing Address - Country:US
Mailing Address - Phone:951-674-5354
Mailing Address - Fax:951-674-5227
Practice Address - Street 1:40329 STETSON AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-7358
Practice Address - Country:US
Practice Address - Phone:951-658-4466
Practice Address - Fax:951-674-5227
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5553101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)