MEDICARE: MR ELECTROLYSIS OC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1417882333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MR ELECTROLYSIS OC

Provider Business Mailing Address
First Line	:	404 WESTMINSTER AVE STE 2
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4237
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 WESTMINSTER AVE STE 2
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4237
Country	:	US
Telephone Number	:	657-289-8733
Fax Number	:	855-607-0007

Authorized Official
Title or Position	:	OWNER
Name	:	ARMANDO REBOLLAR
Credential	:
Telephone Number	:	657-289-8733

Provider Enumeration Date	:	06/13/2026
Last Update Date	:	06/13/2026

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Directions to “MR ELECTROLYSIS OC ” Practice Location

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