=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366430506
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRAIG TIMOTHY MEARS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2005
-----------------------------------------------------
Last Update Date | 02/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BAACH CAMP HUMPHREYS
-----------------------------------------------------
City | APO
-----------------------------------------------------
State | AP
-----------------------------------------------------
Zip | 96271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 0118227134765
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13405 AVENIDA SANTA TECLA UNIT G
-----------------------------------------------------
City | LA MIRADA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90638-3218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-992-5188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | G3608
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | C43322
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------