Provider Demographics
NPI:1952311409
Name:MAYER, MAYER (MD)
Entity Type:Individual
Prefix:MR
First Name:MAYER
Middle Name:
Last Name:MAYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:RALPH
Other - Middle Name:
Other - Last Name:MAYER
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2568 CLARENDON AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255
Mailing Address - Country:US
Mailing Address - Phone:323-582-5444
Mailing Address - Fax:323-584-6992
Practice Address - Street 1:2568 CLARENDON AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255
Practice Address - Country:US
Practice Address - Phone:323-582-5444
Practice Address - Fax:323-584-6992
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69356207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0095860OtherMEDI-CAL PROVIDER NUMBER
CACB245383Medicaid
CAGR0095861OtherMEDI-CAL PROVIDER NUMBER
CAGR0095862OtherMEDI-CAL PROVIDER NUMBER
CAG69356OtherCHDP
CAF77328Medicare UPIN