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General NPI Number Information
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NPI Number | 1588808307
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Entity Type | Organization
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Legal Business Name | REX A. YANNIS, MD, A PROF. CORP.
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Dates
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Enumeration Date | 04/23/2009
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Last Update Date | 04/23/2009
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Provider Practice Location Address
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Address Line | 146 TRAFFIC WAY
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-3376
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Country | US
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Telephone | 805-481-5511
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Fax | 805-481-9631
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Provider Business Mailing Address
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Address Line | 146 TRAFFIC WAY
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-3376
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Country | US
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Telephone | 805-481-5511
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Fax | 805-481-9631
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Authorized Official
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Title or Position | CEO
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Name | DR. REX ANTHONY YANNIS
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Credential | M.D.
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Telephone | 805-481-5511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | C42705
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License Number State | CA
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