=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861657710
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT J. MEHLER, MD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2008
-----------------------------------------------------
Last Update Date | 12/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 416 W LAS TUNAS DR #200
-----------------------------------------------------
City | SAN GABRIEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91776-1236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-281-7461
-----------------------------------------------------
Fax | 626-281-8827
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 416 W LAS TUNAS DR #205
-----------------------------------------------------
City | SAN GABRIEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91776-1236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-281-7461
-----------------------------------------------------
Fax | 626-281-8827
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | MS. ANGELA K BAKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-801-7300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | G12425
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------