Provider Demographics
NPI:1386785715
Name:RALPH MAYER
Entity type:Organization
Organization Name:RALPH MAYER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-743-9050
Mailing Address - Street 1:2700 S FIGUEROA ST
Mailing Address - Street 2:A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3255
Mailing Address - Country:US
Mailing Address - Phone:213-743-9050
Mailing Address - Fax:213-747-7768
Practice Address - Street 1:13309 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-3006
Practice Address - Country:US
Practice Address - Phone:818-899-0069
Practice Address - Fax:818-896-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69356207Q00000X, 207V00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0095861OtherMEDI-CAL PROVIDER NUMBER
CAGR0095861OtherMEDI-CAL PROVIDER NUMBER
CAF77328Medicare UPIN