Provider Demographics
NPI:1871200584
Name:MAHON, MELVYN II (JD)
Entity type:Individual
Prefix:
First Name:MELVYN
Middle Name:
Last Name:MAHON
Suffix:II
Gender:M
Credentials:JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 MABEL ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2419
Mailing Address - Country:US
Mailing Address - Phone:347-525-5538
Mailing Address - Fax:
Practice Address - Street 1:1089 LEA DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3746
Practice Address - Country:US
Practice Address - Phone:510-200-8993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAUNKNOENOtherUNKNOWN