1598843740 NPI number — LOUIE G MAHAIRAS D.P.M.

Table of content: LOUIE G MAHAIRAS D.P.M. (NPI 1598843740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598843740 NPI number — LOUIE G MAHAIRAS D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHAIRAS
Provider First Name:
LOUIE
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAHAIRAS
Provider Other First Name:
LOUIS
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.P.M.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1598843740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27068 LA PAZ RD
Provider Second Line Business Mailing Address:
SUITE 444
Provider Business Mailing Address City Name:
ALISO VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92656-3041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-305-8333
Provider Business Mailing Address Fax Number:
949-305-6333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24953 PASEO DE VALENCIA
Provider Second Line Business Practice Location Address:
SUITE 15C
Provider Business Practice Location Address City Name:
LAGUNA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92653-4342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-305-8333
Provider Business Practice Location Address Fax Number:
949-305-6333
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  E4183 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000E41830 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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