Provider Demographics
NPI:1275819435
Name:R E H MD INC
Entity Type:Organization
Organization Name:R E H MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-229-0227
Mailing Address - Street 1:402 W BROADWAY
Mailing Address - Street 2:SUITE 1270
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3542
Mailing Address - Country:US
Mailing Address - Phone:858-229-0227
Mailing Address - Fax:
Practice Address - Street 1:402 W BROADWAY
Practice Address - Street 2:SUITE 1270
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3542
Practice Address - Country:US
Practice Address - Phone:858-229-0227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24863208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1104899723Medicaid