Provider Demographics
NPI:1396911814
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:PRESIDENT
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 1:1553 GRAND AVE
Mailing Address - Street 2:SUITE B
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 1:1553 GRAND AVE
Practice Address - Street 2:SUITE B
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:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2808213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty