Provider Demographics
NPI:1902916059
Name:MAYER-OAKES, SUSAN ALLISON (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ALLISON
Last Name:MAYER-OAKES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-301-8707
Mailing Address - Fax:
Practice Address - Street 1:1187 COAST VILLAGE RD STE 10A
Practice Address - Street 2:
Practice Address - City:MONTECITO
Practice Address - State:CA
Practice Address - Zip Code:93108-2764
Practice Address - Country:US
Practice Address - Phone:805-565-0020
Practice Address - Fax:805-682-0617
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38844207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE93009Medicare UPIN