Basic Information
| Provider Information | |||||||||
| NPI: | 1821205873 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROHRER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6699 ALVARADO RD | ||||||||
| Address2: | SUITE 2100 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921205238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192293909 | ||||||||
| FaxNumber: | 6192293902 | ||||||||
| Practice Location | |||||||||
| Address1: | 6699 ALVARADO RD | ||||||||
| Address2: | SUITE 2100 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921205238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192293909 | ||||||||
| FaxNumber: | 6192293902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 11/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS13799 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | 20A10396 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | W12026 | 01 | CA | MEDICARE GROUP PTAN | OTHER |