Provider Demographics
NPI:1407029366
Name:LAWRENCE S POHL MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LAWRENCE S POHL MD A PROFESSIONAL CORPORATION
Other - Org Name:MISSION VALLEY MEDICAL CLINC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:POHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-295-3355
Mailing Address - Street 1:5333 MISSION CENTER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1302
Mailing Address - Country:US
Mailing Address - Phone:619-295-3355
Mailing Address - Fax:619-542-1317
Practice Address - Street 1:5333 MISSION CENTER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1302
Practice Address - Country:US
Practice Address - Phone:619-295-3355
Practice Address - Fax:619-542-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43808261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care