Healthcare Provider Details

I. General information

NPI: 1407542442
Provider Name (Legal Business Name): GAIA MOHR-TONACHINI MMSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 LENNON LN
WALNUT CREEK CA
94598-2497
US

IV. Provider business mailing address

323 LENNON LN
WALNUT CREEK CA
94598-2497
US

V. Phone/Fax

Practice location:
  • Phone: 925-430-5335
  • Fax: 925-430-5446
Mailing address:
  • Phone: 925-430-5335
  • Fax: 925-430-5446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA67404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: