=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659476349
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARC RHEINGOLD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2006
-----------------------------------------------------
Last Update Date | 09/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2375 TORRANCE BLVD
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90501-2541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-320-2110
-----------------------------------------------------
Fax | 310-320-2122
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2375 TORRANCE BLVD
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90501-2541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-320-2110
-----------------------------------------------------
Fax | 310-320-2122
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWEN/CPO
-----------------------------------------------------
Name | MR. MARC A RHEINGOLD
-----------------------------------------------------
Credential | CPO
-----------------------------------------------------
Telephone | 310-320-2110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | 0052024
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------