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General NPI Number Information
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NPI Number | 1588288088
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Entity Type | Individual
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Provider Name | MR. RHETT CREEL
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Gender | Male
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Dates
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Enumeration Date | 06/01/2020
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 995 GATEWAY CENTER WAY STE 300
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City | SAN DIEGO
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State | CA
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Zip | 92102-4550
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Country | US
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Telephone | 619-398-2156
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Fax | 619-691-1663
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Provider Business Mailing Address
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Address Line | 995 GATEWAY CENTER WAY STE 300
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City | SAN DIEGO
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State | CA
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Zip | 92102-4550
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Country | US
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Telephone | 619-398-2156
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Fax | 619-398-2156
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 17191
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License Number State | CA
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