Provider Demographics
NPI:1760749709
Name:MAYO, TERRY LEE (RN)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LEE
Last Name:MAYO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:TERRY
Other - Middle Name:LEE
Other - Last Name:MAYO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:4283 EL CAJON BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1289
Mailing Address - Country:US
Mailing Address - Phone:619-521-1743
Mailing Address - Fax:619-521-1896
Practice Address - Street 1:4283 EL CAJON BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1289
Practice Address - Country:US
Practice Address - Phone:619-521-1743
Practice Address - Fax:619-521-1896
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA559923163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse