Provider Demographics
NPI:1558554618
Name:MICHAEL MAYWOOD MD INC
Entity Type:Organization
Organization Name:MICHAEL MAYWOOD MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-453-7209
Mailing Address - Street 1:6919 LA JOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5427
Mailing Address - Country:US
Mailing Address - Phone:858-453-7209
Mailing Address - Fax:858-453-7324
Practice Address - Street 1:6919 LA JOLLA BLVD
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5427
Practice Address - Country:US
Practice Address - Phone:858-453-7209
Practice Address - Fax:858-453-7324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA049016174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty