Basic Information
| Provider Information | |||||||||
| NPI: | 1255335659 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAHON | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1140 W LA VETA AVE STE 430 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928684226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145435555 | ||||||||
| FaxNumber: | 7148362427 | ||||||||
| Practice Location | |||||||||
| Address1: | 1140 W LA VETA AVE STE 430 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928684226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145435555 | ||||||||
| FaxNumber: | 7148362427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2005 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | C41581 | CA | N | Other Service Providers | Specialist | 207RC0000X | C41581 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 060062841 | 01 | CA | RAILROAD MEDICARE | OTHER | DB3373 | 01 | CA | RAILROAD MEDICARE | OTHER | W13988 | 01 | CA | MEDICARE PTAN | OTHER | W13988A | 01 | CA | MEDICARE PTAN | OTHER |