Healthcare Provider Details

I. General information

NPI: 1992035901
Provider Name (Legal Business Name): HORST B. MEHNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 PINE CONE LN
MEADOW VISTA CA
95722-9479
US

IV. Provider business mailing address

3450 PINE CONE LN
MEADOW VISTA CA
95722-9479
US

V. Phone/Fax

Practice location:
  • Phone: 530-878-8312
  • Fax:
Mailing address:
  • Phone: 530-878-8312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAFE35432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: