Provider Demographics
NPI:1528190832
Name:DIABETIC FOOT & WOUND TREATMENT CENTERS
Entity Type:Organization
Organization Name:DIABETIC FOOT & WOUND TREATMENT CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:REHM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:760-744-6226
Mailing Address - Street 1:1553B GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2427
Mailing Address - Country:US
Mailing Address - Phone:760-744-6226
Mailing Address - Fax:760-744-6277
Practice Address - Street 1:1553B GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2427
Practice Address - Country:US
Practice Address - Phone:760-744-6226
Practice Address - Fax:760-744-6277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2808213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGI703AMedicare PIN