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General NPI Number Information
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NPI Number | 1598843740
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Entity Type | Individual
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Provider Name | LOUIE G MAHAIRAS D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 24953 PASEO DE VALENCIA SUITE 15C
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-4342
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Country | US
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Telephone | 949-305-8333
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Fax | 949-305-6333
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Provider Business Mailing Address
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Address Line | 27068 LA PAZ RD SUITE 444
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3041
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Country | US
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Telephone | 949-305-8333
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Fax | 949-305-6333
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E4183
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License Number State | CA
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