Healthcare Provider Details

I. General information

NPI: 1225063092
Provider Name (Legal Business Name): GINA MOHR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25455 BARTON RD SUITE 204B
LOMA LINDA CA
92354-3128
US

IV. Provider business mailing address

54701 FILE NUMBER
LOS ANGELES CA
90074-4701
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-6600
  • Fax:
Mailing address:
  • Phone: 909-651-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberA63598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: