Healthcare Provider Details

I. General information

NPI: 1063146041
Provider Name (Legal Business Name): REHAN MUTTALIB MD INC APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23639 HAWTHORNE BLVD STE 102
TORRANCE CA
90505-5985
US

IV. Provider business mailing address

23639 HAWTHORNE BLVD STE 102
TORRANCE CA
90505-5985
US

V. Phone/Fax

Practice location:
  • Phone: 310-373-9980
  • Fax:
Mailing address:
  • Phone: 310-373-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARLON SANTIAGO
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 310-534-1141