Provider Demographics
NPI:1063388700
Name:MAYO, LEVANDER EUGENE JR
Entity type:Individual
Prefix:MR
First Name:LEVANDER
Middle Name:EUGENE
Last Name:MAYO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3388
Mailing Address - Country:US
Mailing Address - Phone:719-466-7452
Mailing Address - Fax:
Practice Address - Street 1:8616 LA TIJERA BLVD STE 408
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3950
Practice Address - Country:US
Practice Address - Phone:310-337-7827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician