Healthcare Provider Details

I. General information

NPI: 1184867814
Provider Name (Legal Business Name): THOMAS M MAHONEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 SUNRISE BLVD SUITE 2500
CITRUS HEIGHTS CA
95610-2300
US

IV. Provider business mailing address

200 OCEANGATE SUITE 100
LONG BEACH CA
90802-4317
US

V. Phone/Fax

Practice location:
  • Phone: 916-722-2227
  • Fax: 877-860-5422
Mailing address:
  • Phone: 916-564-0521
  • Fax: 877-860-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA54815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: