Provider Demographics
NPI:1083792220
Name:RHOTEN, REX L (MD)
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:L
Last Name:RHOTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PATRICK
Other - Middle Name:
Other - Last Name:RHOTEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4510 EXECUTIVE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3022
Mailing Address - Country:US
Mailing Address - Phone:858-677-9352
Mailing Address - Fax:858-677-9356
Practice Address - Street 1:4510 EXECUTIVE DR STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3022
Practice Address - Country:US
Practice Address - Phone:858-677-9352
Practice Address - Fax:858-677-9356
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62823207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA62623CMedicare PIN