Healthcare Provider Details

I. General information

NPI: 1326886979
Provider Name (Legal Business Name): REX CALIMLIM RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 9TH ST
MARINA CA
93933-6039
US

IV. Provider business mailing address

1061 BRIGANTINO DR
HOLLISTER CA
95023-4290
US

V. Phone/Fax

Practice location:
  • Phone: 831-884-1129
  • Fax: 831-884-1008
Mailing address:
  • Phone: 808-220-1853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number95129956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: