Healthcare Provider Details

I. General information

NPI: 1043902745
Provider Name (Legal Business Name): KIELE TERESA MOHRE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 S DAKOTA AVE BLDG 13850
LOMPOC CA
93437-6307
US

IV. Provider business mailing address

338 S DAKOTA AVE BLDG 13850
LOMPOC CA
93437-6307
US

V. Phone/Fax

Practice location:
  • Phone: 805-606-2273
  • Fax:
Mailing address:
  • Phone: 805-606-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102208938
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: