Provider Demographics
NPI:1043516404
Name:ROHAM, MICHAEL M (PA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:M
Last Name:ROHAM
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:647 CAMINO DE LOS MARES
Mailing Address - Street 2:230
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2825
Mailing Address - Country:US
Mailing Address - Phone:949-230-5343
Mailing Address - Fax:949-218-4868
Practice Address - Street 1:302 N EL CAMINO REAL STE 112
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4776
Practice Address - Country:US
Practice Address - Phone:949-489-9898
Practice Address - Fax:949-489-2569
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2020-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA15771363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical