Provider Demographics
NPI:1063503779
Name:MAHURIN, EDVIRD ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDVIRD
Middle Name:ARTHUR
Last Name:MAHURIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32144 AGOURA RD STE 114
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4044
Mailing Address - Country:US
Mailing Address - Phone:818-889-1818
Mailing Address - Fax:818-889-8638
Practice Address - Street 1:32144 AGOURA RD STE 114
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4044
Practice Address - Country:US
Practice Address - Phone:818-889-1818
Practice Address - Fax:818-889-8638
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA17747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A17747Medicaid
CAA21044Medicare UPIN
CAA17747Medicare ID - Type UnspecifiedMEDICARE ID NUMBER