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General NPI Number Information
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NPI Number | 1790984276
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Entity Type | Individual
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Provider Name | MANON BROOKE MASHBURN MD
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Gender | Female
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 5325 BRODER BLVD
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City | DUBLIN
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State | CA
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Zip | 94568-3309
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Country | US
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Telephone | 925-551-6740
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Fax |
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Provider Business Mailing Address
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Address Line | 3183 LANSDOWN CT
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City | PLEASANTON
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State | CA
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Zip | 94588-3527
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Country | US
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Telephone | 45-975-2373
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Fax |
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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 | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number | MD.200800
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 200800
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C-172128
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License Number State | CA
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