Provider Demographics
NPI:1740382787
Name:DOCTOLERO, REX T (PA)
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:T
Last Name:DOCTOLERO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 N SHARON AVE
Mailing Address - Street 2:#100
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3386
Mailing Address - Country:US
Mailing Address - Phone:559-449-1100
Mailing Address - Fax:559-449-1174
Practice Address - Street 1:7130 N SHARON AVE
Practice Address - Street 2:#100
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3386
Practice Address - Country:US
Practice Address - Phone:559-449-1100
Practice Address - Fax:559-449-1174
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPA18009363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PA180090Medicare PIN