Mortensen, John W
Mortensen, John W is an individual health care provider with primary practice located at 2 W Fern Ave , Redlands CA 92373-5916. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Mortensen, John W can be contacted via phone (909) 793-3311.Contact Information
Primary practice address
2 W Fern Ave
Redlands CA 92373-5916
Phone: (909) 793-3311
Fax: (909) 796-4158
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | G15412 | California |
Profile Details
| NPI number | 1023057130 |
|---|---|
| LBN Legal business name | Mortensen, John W |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 5th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1023057130 | NPPES |
| California | MEDICAID | 00G154122 |
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