Provider Demographics
NPI:1093201741
Name:MAHA, SHERWIN S
Entity type:Individual
Prefix:
First Name:SHERWIN
Middle Name:S
Last Name:MAHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 KNOLLWOOD CT
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-1207
Mailing Address - Country:US
Mailing Address - Phone:408-470-9396
Mailing Address - Fax:
Practice Address - Street 1:533 KNOLLWOOD CT
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-1207
Practice Address - Country:US
Practice Address - Phone:408-470-9396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15083416OtherKAISER PERMANENTE