Provider Demographics
NPI:1992051205
Name:MOHLE-BOETANI, JANET CAROL (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:CAROL
Last Name:MOHLE-BOETANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 MONTEREY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-2508
Mailing Address - Country:US
Mailing Address - Phone:916-956-6493
Mailing Address - Fax:
Practice Address - Street 1:520 I ST
Practice Address - Street 2:220-08
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-2334
Practice Address - Country:US
Practice Address - Phone:916-956-6493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG650382083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine