Healthcare Provider Details

I. General information

NPI: 1134212467
Provider Name (Legal Business Name): KATHLEEN MAHON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 W POST RD
LAS VEGAS NV
89148-2418
US

IV. Provider business mailing address

2598 WINDMILL PKWY
HENDERSON NV
89074-5476
US

V. Phone/Fax

Practice location:
  • Phone: 702-255-6665
  • Fax: 702-255-2994
Mailing address:
  • Phone: 702-896-6043
  • Fax: 702-896-9591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberNV3988
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: