Individual
LISA M MAHONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
26520 CACTUS AVE, MORENO VALLEY, CA 92555-3927
(951) 486-4072
Mailing address
26520 CACTUS AVE, MORENO VALLEY, CA 92555-3927
(951) 486-4072
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
01062028
IN
2085R0202X
Diagnostic Radiology Physician
Primary
01062028
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200827180
—
IN
Enumeration date
06/27/2006
Last updated
09/20/2021
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