Provider Demographics
NPI:1265591994
Name:MAYO, GEORGE L (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:L
Last Name:MAYO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16543 BROOKHURST ST.
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:714-531-6296
Mailing Address - Fax:714-531-6236
Practice Address - Street 1:16543 BROOKHURST ST.
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-531-6296
Practice Address - Fax:714-531-6236
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG83501207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG83501AOtherPTAN
H91705Medicare UPIN