1487753448 NPI number — RICHARD A MAYER MD INC

Table of content: (NPI 1487753448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487753448 NPI number — RICHARD A MAYER MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD A MAYER MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487753448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4231 BALBOA AVE STE 218
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92117-5504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-462-9010
Provider Business Mailing Address Fax Number:
619-287-9058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4231 BALBOA AVE STE 218
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-5504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-754-4955
Provider Business Practice Location Address Fax Number:
619-287-9058
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAYER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
619-462-9010

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A792460 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: WA79246C . This is a "PROVIDER TRANSACTION ACCESS NUMBER" identifier . This identifiers is of the category "OTHER".




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