Provider Demographics
NPI:1235209933
Name:MAHONEY, MARIA FISHER WALLIS (ATC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:FISHER WALLIS
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:FISHER
Other - Last Name:WALLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:4326 MODOC ROAD
Mailing Address - Street 2:UNIT C
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1846
Mailing Address - Country:US
Mailing Address - Phone:805-683-6123
Mailing Address - Fax:
Practice Address - Street 1:STUDENT HEALTH SERVICE
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93106-7002
Practice Address - Country:US
Practice Address - Phone:805-893-2914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer