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General NPI Number Information
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NPI Number | 1710328158
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Entity Type | Organization
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Legal Business Name | PHILLIP RECHISTER
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 30010 N LAKE DR
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-1227
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Country | US
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Telephone | 877-577-4327
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Fax | 847-620-1055
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Provider Business Mailing Address
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Address Line | 30010 N. LAKE DR.
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City | LAKE ELSINORE
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State | CA
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Zip | 92530
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHILLIP RECHISTER
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Credential |
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Telephone | 877-577-4327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | HA3570
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License Number State | CA
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