MEDICARE: MRS. BARBARA ANN MAHONEY RNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	RN255920	CA

General Provider Information

NPI Number	:	1578560199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BARBARA ANN MAHONEY RNP

Provider Business Mailing Address
First Line	:	2476 N BEECHWOOD AVE
Second Line	:
City	:	RIALTO
State	:	CA
Zip	:	92377-4239
Country	:	US
Telephone Number	:	909-820-0741
Fax Number	:	909-820-4609

Provider Business Practice Location Address
First Line	:	9961 SIERRA AVE
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92335-6720
Country	:	US
Telephone Number	:	909-427-6896
Fax Number	:	909-427-2663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	03/07/2023

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