Provider Demographics
NPI:1396977930
Name:MAHLLER, YONATAN (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:YONATAN
Middle Name:
Last Name:MAHLLER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2009-08-16
Last Update Date:2018-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117135207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA117135OtherCA LICENSE