Healthcare Provider Details

I. General information

NPI: 1316050404
Provider Name (Legal Business Name): REX PAUL ANDERSON C.PED., HAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 LYTTON AVE. SUITE 1
PALO ALTO CA
94301
US

IV. Provider business mailing address

480 LYTTON AVE STE 1
PALO ALTO CA
94301-1536
US

V. Phone/Fax

Practice location:
  • Phone: 408-761-5023
  • Fax: 408-761-5023
Mailing address:
  • Phone: 408-761-5023
  • Fax: 408-228-0608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2456
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number7620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: