Basic Information
| Provider Information | |||||||||
| NPI: | 1689744518 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAUS | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 COURAGE DR | ||||||||
| Address2: | MS 10-100 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945336717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077842048 | ||||||||
| FaxNumber: | 7077842032 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 COURAGE DR | ||||||||
| Address2: | MS 10-100 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945336717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077842048 | ||||||||
| FaxNumber: | 7077842032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 04/15/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A5128 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00AX51280 | 05 | CA | MEDICAID |