MEDICARE: PROFESSIONAL AND PERSONAL EXCELLENCE INTERNATIONAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY 17124	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1295836138	OTHER	INDIVIDUAL NPI - DOLORES RODRIGUEZ-REIMANN, PH.D.
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1154422087	OTHER	INDIVIDUAL NPI - JOACHIM REIMANN, PH.D.

General Provider Information

NPI Number	:	1205143807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL AND PERSONAL EXCELLENCE INTERNATIONAL

Provider Business Mailing Address
First Line	:	3530 CAMINO DEL RIO N
Second Line	:	SUITE 103
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1743
Country	:	US
Telephone Number	:	619-991-0591
Fax Number	:	858-536-9637

Provider Business Practice Location Address
First Line	:	3530 CAMINO DEL RIO N
Second Line	:	SUITE 103
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1743
Country	:	US
Telephone Number	:	619-991-0591
Fax Number	:	858-536-9637

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DOLORES I RODRIGUEZ-REIMANN
Credential	:	PH.D.
Telephone Number	:	619-991-0591

Provider Enumeration Date	:	09/03/2010
Last Update Date	:	09/03/2010

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