Provider Demographics
NPI:1598843740
Name:MAHAIRAS, LOUIE G (DPM)
Entity Type:Individual
Prefix:
First Name:LOUIE
Middle Name:G
Last Name:MAHAIRAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:LOUIS
Other - Middle Name:G
Other - Last Name:MAHAIRAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:27068 LA PAZ RD
Mailing Address - Street 2:SUITE 444
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3041
Mailing Address - Country:US
Mailing Address - Phone:949-305-8333
Mailing Address - Fax:949-305-6333
Practice Address - Street 1:24953 PASEO DE VALENCIA
Practice Address - Street 2:SUITE 15C
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4342
Practice Address - Country:US
Practice Address - Phone:949-305-8333
Practice Address - Fax:949-305-6333
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4183213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E41830Medicaid
CA000E41830Medicaid
CA5507180001Medicare NSC