Healthcare Provider Details

I. General information

NPI: 1023124294
Provider Name (Legal Business Name): KATHLEEN BERNICE MAHONY F.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 E ALESSANDRO BLVD #9803
RIVERSIDE CA
92508-6071
US

IV. Provider business mailing address

491 E ALESSANDRO BLVD
RIVERSIDE CA
92508-6071
US

V. Phone/Fax

Practice location:
  • Phone: 951-780-1835
  • Fax: 951-780-2936
Mailing address:
  • Phone: 951-780-1835
  • Fax: 951-780-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11410
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN300198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: