Modern Man TRT LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MODERN MAN TRT LLC

Practice address

4306 W Point Loma Blvd Apt D
San Diego, CA 92107-1165

Phone

(619) 356-8973

NPI assigned

May 6, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Hortareas, DO

Title

Owner

Phone

(619) 356-8973

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714953600000",
    "number": "1811744907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4306 W POINT LOMA BLVD APT D",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921071165",
            "telephone_number": "619-356-8973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4306 W POINT LOMA BLVD APT D",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921071165",
            "telephone_number": "619-356-8973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN MAN TRT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-06",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A",
        "authorized_official_last_name": "HORTAREAS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-356-8973",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Young-Mi Grace Moceri, M.S., OTR/L
• Sean Mackenzie Mock
• Shawn David Mock, C.P, D.C
• Michael Moctezuma
• Moden Medical Group
• Modern Meridians
• Modern Therapies LLC
• Modernhealth Holdings Inc
• Lucia Modesti, M.D.
• Modesto Radiological Medical Group, Inc

• Internal Medicine Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.

Verify at the official NPI Registry.