Healthcare Provider Details

I. General information

NPI: 1366430506
Provider Name (Legal Business Name): CRAIG TIMOTHY MEARS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BAACH CAMP HUMPHREYS
APO AP
96271
US

IV. Provider business mailing address

13405 AVENIDA SANTA TECLA UNIT G
LA MIRADA CA
90638-3218
US

V. Phone/Fax

Practice location:
  • Phone: 0118227134765
  • Fax:
Mailing address:
  • Phone: 949-992-5188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG3608
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC43322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: