Mayflower Medical Group, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A94585 Issued in CA

Legal business name

MAYFLOWER MEDICAL GROUP, INC.

Practice address

1433 N. Hollenbeck Ave.
Suite 200
Covina, CA 91722

Phone

(626) 331-2209

Fax

(626) 967-1410

NPI assigned

Jun 2, 2006

Last updated

Jun 25, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Araceli Fuentes

Title

Contracts Manager

Phone

(626) 800-1200

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Mayflower Medical Group, Inc.

  • Internal Medicine Physician
  • West Covina, CA
  • NPI 1003188160

  O20061120000235

  Same enrollment

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Khaled Ahmed Aly Mawaheb, M.D.

  • Family Medicine Physician
  • Covina, CA
  • NPI 1356492888
  NPD
• Adelaide Willis, MD

  • Family Medicine Physician
  • West Covina, CA
  • NPI 1073561346
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561420800000",
    "number": "1932146370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1433 N. HOLLENBECK AVE.",
            "address_2": "SUITE 200, 100, 104",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "91722",
            "telephone_number": "626-331-2209",
            "fax_number": "626-967-1410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1433 N. HOLLENBECK AVE.",
            "address_2": "SUITE 200",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "91722",
            "telephone_number": "626-331-2209",
            "fax_number": "626-967-1410"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1433 N Hollenbeck Ave Ste 104",
            "address_purpose": "LOCATION",
            "city": "Covina",
            "state": "CA",
            "postal_code": "917221558",
            "country_code": "US",
            "telephone_number": "626-914-0017",
            "fax_number": "626-914-0288",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAYFLOWER MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2019-06-25",
        "status": "A",
        "authorized_official_last_name": "FUENTES",
        "authorized_official_first_name": "ARACELI",
        "authorized_official_title_or_position": "CONTRACTS MANAGER",
        "authorized_official_telephone_number": "626-800-1200"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A94585",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A96423",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A46009",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Paul Maxam
• Lauren Camille May
• Portia May
• Barbara Mayberry
• Mayflower Medical Group, Inc.
• Emilio Isaias Mazon
• Daniel Mazur
• Kelechi Adanna Mbaruguru
• Alisa Faye McAleer, MS, RD, CDCES
• Cathleen Ann McBirney

• Family Medicine Physician in Covina, CA
• Providers in Covina, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.