Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary |
NPI | 1194991224 |
---|---|
Provider Name | Colleen E. Mahoney |
First Address | Hermosa Beach, CA 90254-2611 |
Second Address | Los Angeles, CA 90015-1329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2008 |
Last Update Date | 08/05/2008 |