| Doctor Name: | MR. MICHAEL M ROHAM |
| NPI Number: | 1043516404 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA. |
| License Number: | PA15771 |
| Business Practice Address: | 647 Camino De Los Mares Suite 230 San Clemente, CA - 926732825 |
| Business Phone Number: | 9492184868 |
| Business Fax Number: | 9492184868 |
| Mailing Address: | 647 Camino De Los Mares, 230 SAN CLEMENTE |
| State: | CA |
| Postal Code: | 926732825 |
| Phone Number: | 9492305343 |
| Fax Number: | 9492184868 |
| NPI Enumeration Date: | 02/02/2011 |
| NPI Last Update Date: | 12/07/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA15771 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |