Provider Demographics
NPI:1235208489
Name:MAYES, ERIC LAWAYNE SR (INDEPENDENT DUTY HM)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LAWAYNE
Last Name:MAYES
Suffix:SR
Gender:M
Credentials:INDEPENDENT DUTY HM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30394 SIERRA MADRE DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-7306
Mailing Address - Country:US
Mailing Address - Phone:971-952-4360
Mailing Address - Fax:
Practice Address - Street 1:30394 SIERRA MADRE DR
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-7306
Practice Address - Country:US
Practice Address - Phone:951-972-4360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2008-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman