Healthcare Provider Details

I. General information

NPI: 1376526020
Provider Name (Legal Business Name): REX E THORNHILL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 9TH ST. SUITE 2C
PASO ROBLES CA
93446
US

IV. Provider business mailing address

806 9TH ST SUITE 2C
PASO ROBLES CA
93446
US

V. Phone/Fax

Practice location:
  • Phone: 805-239-3136
  • Fax: 805-239-3137
Mailing address:
  • Phone: 805-239-3136
  • Fax: 805-239-3137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000E3592
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0263310002
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE3592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: