Healthcare Provider Details

I. General information

NPI: 1417882333
Provider Name (Legal Business Name): MR ELECTROLYSIS OC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 WESTMINSTER AVE STE 2
NEWPORT BEACH CA
92663-4237
US

IV. Provider business mailing address

404 WESTMINSTER AVE STE 2
NEWPORT BEACH CA
92663-4237
US

V. Phone/Fax

Practice location:
  • Phone: 657-289-8733
  • Fax: 855-607-0007
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ARMANDO REBOLLAR
Title or Position: OWNER
Credential:
Phone: 657-289-8733