MEDICARE: PEDIATRIC PARTNERS MEDICAL PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1720176845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC PARTNERS MEDICAL PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	27699 JEFFERSON AVE
Second Line	:	SUITE 300
City	:	TEMECULA
State	:	CA
Zip	:	92590-2661
Country	:	US
Telephone Number	:	951-252-8588
Fax Number	:	951-252-8589

Provider Business Practice Location Address
First Line	:	3989 W STETSON AVE
Second Line	:
City	:	HEMET
State	:	CA
Zip	:	92545-9695
Country	:	US
Telephone Number	:	951-765-7002
Fax Number	:	866-390-9162

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	THOMAS P MOHR
Credential	:	M.D.
Telephone Number	:	951-252-8588

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	12/08/2010

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