Healthcare Provider Details

I. General information

NPI: 1992771604
Provider Name (Legal Business Name): JOHN E BOHM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W COLE BLVD STE B
CALEXICO CA
92231-9700
US

IV. Provider business mailing address

5267 WARNER AVE # 341
HUNTINGTON BEACH CA
92649-4079
US

V. Phone/Fax

Practice location:
  • Phone: 760-890-0190
  • Fax: 760-890-0160
Mailing address:
  • Phone: 310-993-6912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA051741
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: