Provider Demographics
NPI:1821372285
Name:ROBERT M. MAYWOOD, MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ROBERT M. MAYWOOD, MD A PROFESSIONAL CORPORATION
Other - Org Name:RMM ORTHOPAEDICS
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING LIASON
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-616-6400
Mailing Address - Street 1:3444 KEARNY VILLA RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1959
Mailing Address - Country:US
Mailing Address - Phone:858-616-6400
Mailing Address - Fax:858-616-6936
Practice Address - Street 1:3444 KEARNY VILLA RD
Practice Address - Street 2:SUITE 401
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1964
Practice Address - Country:US
Practice Address - Phone:858-616-6400
Practice Address - Fax:858-616-6936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU22831Medicare UPIN
CAH03615Medicare UPIN
CAG96726Medicare UPIN