MEDICARE: JANET CAROL MOHLE-BOETANI MD

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	2083P0901X	Public Health & General Preventive Medicine Physician	G65038	CA

General Provider Information

NPI Number	:	1992051205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET CAROL MOHLE-BOETANI MD

Provider Business Mailing Address
First Line	:	1270 MONTEREY BLVD
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94127-2508
Country	:	US
Telephone Number	:	916-956-6493
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 I ST
Second Line	:	220-08
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-2334
Country	:	US
Telephone Number	:	916-956-6493
Fax Number	:

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

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	07/24/2012

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