Provider Demographics
NPI:1851331854
Name:MAHONEY, WILLIAM THOMAS (PA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:THOMAS
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4929
Mailing Address - Country:US
Mailing Address - Phone:626-441-3018
Mailing Address - Fax:
Practice Address - Street 1:15725 WHITTIER BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2347
Practice Address - Country:US
Practice Address - Phone:562-947-0059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11927363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P95279Medicare UPIN
CADN190YMedicare PIN