Active NPI
Thomas Wolfgang Mehlmauer Klotz, M.D.
- Psychiatry Physician
- San Clemente, CA
National Provider Identifier
1396109179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 77564
- Practice address
- 62305 8TH St
San Clemente, CA 92672 - Phone
- (760) 763-6058
- Fax
- (626) 380-0783
- NPI assigned
- Apr 7, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychiatry Physician | 2084P0800X | 77564 | CA | Primary |
Addresses
Primary practice location
62305 8TH St
San Clemente, CA 92672
Mailing address
34800 Bob Wilson Dr
San Diego, CA 92134-1108
Phone (619) 532-8555
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 77564 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723593600000",
"number": "1396109179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34800 BOB WILSON DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921341108",
"telephone_number": "619-532-8555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "62305 8TH ST",
"city": "SAN CLEMENTE",
"state": "CA",
"postal_code": "92672",
"telephone_number": "760-763-6058",
"fax_number": "626-380-0783"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLOTZ",
"first_name": "THOMAS",
"middle_name": "WOLFGANG MEHLMAUER",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-04-07",
"last_updated": "2024-08-14",
"certification_date": "2024-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "77564",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Clemente, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.