Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A63598 | CA |
NPI | 1225063092 |
---|---|
Provider Name | Dr. Gina Mohr |
First Address | Los Angeles, CA 90074-4701 |
Second Address | Loma Linda, CA 92354-3128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 16/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A635980 | (05) | CA |
G94373 | (02) |