Provider Demographics
NPI:1396109179
Name:KLOTZ, THOMAS WOLFGANG MEHLMAUER (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WOLFGANG MEHLMAUER
Last Name:KLOTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-1108
Mailing Address - Country:US
Mailing Address - Phone:619-532-8555
Mailing Address - Fax:
Practice Address - Street 1:62305 8TH ST
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672
Practice Address - Country:US
Practice Address - Phone:760-763-6058
Practice Address - Fax:626-380-0783
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA775642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVAD0000Medicare UPIN