Provider Demographics
NPI:1063833184
Name:YONATAN MAHLLER MD PHD INC
Entity Type:Organization
Organization Name:YONATAN MAHLLER MD PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YONATAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHLLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:513-304-1011
Mailing Address - Street 1:355 PLACENTIA AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3304
Mailing Address - Country:US
Mailing Address - Phone:949-375-8244
Mailing Address - Fax:949-398-9812
Practice Address - Street 1:355 PLACENTIA AVE STE 302
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3304
Practice Address - Country:US
Practice Address - Phone:949-375-8244
Practice Address - Fax:949-398-9812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117135207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty