Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | G61668 | CA |
NPI | 1013016781 |
---|---|
Provider Name | Thomas Paul Mohr |
First Address | Temecula, CA 92590-2661 |
Second Address | Hemet, CA 92543-7976 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 10/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G616680 | MEDI-CAL PROVIDER NUMBER (01) | CA |