Provider Demographics
NPI:1013739689
Name:MAYAN MEDICAL CLINIC
Entity type:Organization
Organization Name:MAYAN MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:F
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:310-707-7768
Mailing Address - Street 1:11827 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-1119
Mailing Address - Country:US
Mailing Address - Phone:310-707-7768
Mailing Address - Fax:
Practice Address - Street 1:1800 W 6TH ST STE 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3139
Practice Address - Country:US
Practice Address - Phone:213-483-9996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care