Provider Demographics
NPI:1578555215
Name:REXINGER, ELWYN LOREN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELWYN
Middle Name:LOREN
Last Name:REXINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:831 VIA SUERTE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6531
Mailing Address - Country:US
Mailing Address - Phone:949-364-5600
Mailing Address - Fax:949-364-2231
Practice Address - Street 1:831 VIA SUERTE
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6531
Practice Address - Country:US
Practice Address - Phone:949-364-5600
Practice Address - Fax:949-364-2231
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16725207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39879Medicare UPIN
CAWG16725AMedicare ID - Type Unspecified
CAEM216YMedicare PIN
CAEM216ZMedicare PIN