=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528776564
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RUME MEDICAL GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2022
-----------------------------------------------------
Last Update Date | 08/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2729 BRISTOL ST
-----------------------------------------------------
City | COSTA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92626-7930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 657-256-8995
-----------------------------------------------------
Fax | 866-461-2312
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2729 BRISTOL ST
-----------------------------------------------------
City | COSTA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92626-7930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-340-1322
-----------------------------------------------------
Fax | 714-880-7111
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MATTHEW WAYNE ABINANTE
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 714-916-5210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------