Provider Demographics
NPI:1528583986
Name:MAYHEW, BRENT HENRY (CATC, CCS)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:HENRY
Last Name:MAYHEW
Suffix:
Gender:M
Credentials:CATC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 S BEACON ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-4324
Mailing Address - Country:US
Mailing Address - Phone:310-514-9307
Mailing Address - Fax:
Practice Address - Street 1:9901 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6713
Practice Address - Country:US
Practice Address - Phone:562-484-3385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program