Basic Information
| Provider Information | |||||||||
| NPI: | 1346855574 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOARAN | ||||||||
| FirstName: | MAYVERA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 964 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907140964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622621496 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4510 E PACIFIC COAST HWY STE 600 | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908046914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5623461100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2020 | ||||||||
| LastUpdateDate: | 09/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.