MEDICARE: BONNIE MAHLER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY12364	CA

General Provider Information

NPI Number	:	1427134188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE MAHLER PH.D.

Provider Business Mailing Address
First Line	:	23504 LYONS AVE STE 401
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91321-5777
Country	:	US
Telephone Number	:	661-260-3131
Fax Number	:	661-255-2093

Provider Business Practice Location Address
First Line	:	23504 LYONS AVE STE 401
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91321-5777
Country	:	US
Telephone Number	:	661-260-3131
Fax Number	:	661-255-2093

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/08/2007

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