=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275819435
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R E H MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2011
-----------------------------------------------------
Last Update Date | 11/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 402 W BROADWAY SUITE 1270
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92101-3542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-229-0227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 402 W BROADWAY SUITE 1270
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92101-3542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-229-0227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RALPH E HOLMES
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 858-229-0227
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | G24863
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------