Individual
MR. MICHAEL SCOTT MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
425 HAALAND DR STE 102, THOUSAND OAKS, CA 91361-5230
(805) 723-8008
Mailing address
3713 CORTE DE LOS REYES, THOUSAND OAKS, CA 91360-7025
(805) 529-3475
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
56485
CA
Other
Enumeration date
07/24/2019
Last updated
07/24/2019
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