Provider Demographics
NPI:1447257845
Name:MAHONEY, ALVIN R (MD)
Entity type:Individual
Prefix:MR
First Name:ALVIN
Middle Name:R
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2222 FOOTHILL BLVD
Mailing Address - Street 2:# E570
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1456
Mailing Address - Country:US
Mailing Address - Phone:818-636-8562
Mailing Address - Fax:888-235-1709
Practice Address - Street 1:14850 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4618
Practice Address - Country:US
Practice Address - Phone:818-904-3635
Practice Address - Fax:888-235-1709
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG599312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G599310Medicaid
CAG59931Medicare PIN
E41861Medicare UPIN