=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508041575
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENNETH REHM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2008
-----------------------------------------------------
Last Update Date | 06/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1553 GRAND AVE
-----------------------------------------------------
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
-----------------------------------------------------
City | SAN MARCOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92078-2427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-744-6226
-----------------------------------------------------
Fax | 760-744-6277
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KENNETH BRUCE REHM
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 760-744-6226
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------