Provider Demographics
NPI:1134598931
Name:MAYORGA, XOCHITL
Entity type:Individual
Prefix:
First Name:XOCHITL
Middle Name:
Last Name:MAYORGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BROADWAY ST
Mailing Address - Street 2:SUITE 70
Mailing Address - City:KING CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93930-2865
Mailing Address - Country:US
Mailing Address - Phone:831-755-4353
Mailing Address - Fax:
Practice Address - Street 1:200 BROADWAY ST
Practice Address - Street 2:SUITE 70
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-2865
Practice Address - Country:US
Practice Address - Phone:831-755-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist