Provider Demographics
NPI:1578772380
Name:MAHAN, CIARA ANNE (MS)
Entity Type:Individual
Prefix:
First Name:CIARA
Middle Name:ANNE
Last Name:MAHAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 MOWRY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1460
Mailing Address - Country:US
Mailing Address - Phone:510-745-9151
Mailing Address - Fax:510-745-9152
Practice Address - Street 1:3550 MOWRY AVE STE 102
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1460
Practice Address - Country:US
Practice Address - Phone:510-745-9151
Practice Address - Fax:510-745-9152
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program