Provider Demographics
NPI:1285811695
Name:MAURO, MICHAEL DAVID (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:MAURO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16702 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-5824
Mailing Address - Country:US
Mailing Address - Phone:714-367-5360
Mailing Address - Fax:714-367-5051
Practice Address - Street 1:16702 VALLEY VIEW AVE
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-5824
Practice Address - Country:US
Practice Address - Phone:562-921-0341
Practice Address - Fax:562-404-0266
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203398207X00000X
CA20A15837207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1285811695OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1285811695Medicaid
VA1285811695OtherMAJESTACARE
VA1285811695OtherHUMANA MEDICARE
VA1285811695OtherHEALTHKEEPERS PLUS
VA1285811695OtherINTOTAL
VA1585811695OtherVIRGINIA HEALTH NETWORK
VA1285811695OtherAETNA
VA1285811695OtherGATEWAY
VA1285811695OtherVA PREMIER
VA541586601166OtherTRICARE
VA1285811695OtherUMWA
VA1585811695OtherCIGNA
VA1285811695OtherUNITED HEALTHCARE
VA1285811695OtherANTHEM
VA1285811695OtherHEALTHKEEPERS
VA1585811695OtherOPTIMA HEALTH PLAN
VA1285811695OtherUNITED HEALTHCARE