Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | A25323 | CA |
NPI | 1811179120 |
---|---|
Provider Name | John Joseph Rehm |
First Address | Manhattan Beach, CA 90267-1118 |
Second Address | Manhattan Beach, CA 90266-2727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2007 |
Last Update Date | 28/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A24381 | (02) | CA |