Healthcare Provider Details

I. General information

NPI: 1265224620
Provider Name (Legal Business Name): KAESON REMPEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11617 ENCANTO LN
COLTON CA
92324-9737
US

IV. Provider business mailing address

11617 ENCANTO LN
COLTON CA
92324-9737
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-0850
  • Fax:
Mailing address:
  • Phone: 909-580-0850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number94029830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: