Provider Demographics
NPI:1326234204
Name:MOHS-TEK, INC.
Entity Type:Organization
Organization Name:MOHS-TEK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SEEMA
Authorized Official - Middle Name:G
Authorized Official - Last Name:BHUTANI
Authorized Official - Suffix:
Authorized Official - Credentials:HT
Authorized Official - Phone:949-551-6647
Mailing Address - Street 1:PO BOX 1150
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-1150
Mailing Address - Country:US
Mailing Address - Phone:949-551-6647
Mailing Address - Fax:949-653-0200
Practice Address - Street 1:1342 BELL AVE STE 3H
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6440
Practice Address - Country:US
Practice Address - Phone:949-551-6647
Practice Address - Fax:949-559-6647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99039304291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAX05D000012Medicare PIN