Provider Demographics
NPI:1770666828
Name:ENDOCRINE CONSULTANTS AND SPECIALISTS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:ENDOCRINE CONSULTANTS AND SPECIALISTS MEDICAL GROUP INC
Other - Org Name:THE ENDOCRINE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:MAYEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-285-1904
Mailing Address - Street 1:1140 W LA VETA
Mailing Address - Street 2:STE 420
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-285-1904
Mailing Address - Fax:714-571-5979
Practice Address - Street 1:1140 W LA VETA
Practice Address - Street 2:SUITE 420
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-285-1904
Practice Address - Fax:714-571-5979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A36393Medicare UPIN
CAW10995Medicare ID - Type Unspecified