=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396911814
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIABETIC FOOT & WOUND TREATMENT CENTERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2008
-----------------------------------------------------
Last Update Date | 05/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1553 GRAND AVE SUITE B
-----------------------------------------------------
City | SAN MARCOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92078-2427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-744-6226
-----------------------------------------------------
Fax | 760-744-6277
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1553 GRAND AVE SUITE B
-----------------------------------------------------
City | SAN MARCOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92078-2427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-744-6226
-----------------------------------------------------
Fax | 760-744-6277
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KENNETH B REHM
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 760-744-6226
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | E2808
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------