Provider Demographics
NPI:1609144039
Name:MOHAWK MEDICAL & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MOHAWK MEDICAL & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEL TORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-847-3231
Mailing Address - Street 1:PO BOX 9879
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389-1879
Mailing Address - Country:US
Mailing Address - Phone:661-321-3288
Mailing Address - Fax:661-847-3267
Practice Address - Street 1:9908 BRIMHALL RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2801
Practice Address - Country:US
Practice Address - Phone:661-321-3288
Practice Address - Fax:661-847-3267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39608207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47877Medicare UPIN