Basic Information
| Provider Information | |||||||||
| NPI: | 1104826189 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAYFIELD | ||||||||
| FirstName: | TANYA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4300 ROSE DR | ||||||||
| Address2: | |||||||||
| City: | YORBA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928862026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145776677 | ||||||||
| FaxNumber: | 7145776635 | ||||||||
| Practice Location | |||||||||
| Address1: | 4300 ROSE DR | ||||||||
| Address2: | |||||||||
| City: | YORBA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928862026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145776677 | ||||||||
| FaxNumber: | 7145776635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G67254 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 208000000X | G67254 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.