Provider Demographics
NPI:1669685012
Name:MAYORAL, MARIA ELENA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ELENA
Last Name:MAYORAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:E
Other - Last Name:HOLLOMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1527 WILSHIRE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-2205
Mailing Address - Country:US
Mailing Address - Phone:213-413-1396
Mailing Address - Fax:213-413-7782
Practice Address - Street 1:1527 WILSHIRE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-2205
Practice Address - Country:US
Practice Address - Phone:213-413-1396
Practice Address - Fax:213-413-7782
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA262042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry