MEDICARE: REMINGTON CLAIRE MAHLUM PA-C

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	363AS0400X	Surgical Physician Assistant	PA67759	CA

General Provider Information

NPI Number	:	1801768288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REMINGTON CLAIRE MAHLUM PA-C

Provider Business Mailing Address
First Line	:	3020 CHILDRENS WAY
Second Line	:	MC5003
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4223
Country	:	US
Telephone Number	:	858-576-1700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 CHILDRENS WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4232
Country	:	US
Telephone Number	:	858-966-7711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2025
Last Update Date	:	02/02/2026

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Directions to “ REMINGTON CLAIRE MAHLUM PA-C” Practice Location

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