Healthcare Provider Details

I. General information

NPI: 1144831702
Provider Name (Legal Business Name): MR. CAMERON MICHAEL REHMANI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2020
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10542 VILLA DEL CERRO
SANTA ANA CA
92705-1486
US

IV. Provider business mailing address

10542 VILLA DEL CERRO
SANTA ANA CA
92705-1486
US

V. Phone/Fax

Practice location:
  • Phone: 714-833-6027
  • Fax:
Mailing address:
  • Phone: 714-833-6027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberINT46519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: