Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G28511 | CA |
N | 207ND0900X | Dermatopathologist | G28511 | CA |
N | 207NS0135X | Procedural Dermatology | G28511 | CA |
NPI | 1376563445 |
---|---|
Provider Name | Dr. Paul A Rehder |
First Address | Oxnard, CA 93036-2213 |
Second Address | Oxnard, CA 93036-2213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 24/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G285110 | MEDI-CAL (01) | |
G28511 | STATE LICENSE (01) | CA |