Basic Information
| Provider Information | |||||||||
| NPI: | 1407029366 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LAWRENCE S POHL MD A PROFESSIONAL CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MISSION VALLEY MEDICAL CLINC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5333 MISSION CENTER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921081302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192953355 | ||||||||
| FaxNumber: | 6195421317 | ||||||||
| Practice Location | |||||||||
| Address1: | 5333 MISSION CENTER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921081302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192953355 | ||||||||
| FaxNumber: | 6195421317 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2008 | ||||||||
| LastUpdateDate: | 05/14/2009 | ||||||||
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| AuthorizedOfficialLastName: | POHL | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | STUART | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6192953355 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | G43808 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.