Provider Demographics
NPI:1316050404
Name:ANDERSON, REX PAUL (CPED, HAS)
Entity type:Individual
Prefix:MR
First Name:REX
Middle Name:PAUL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:CPED, HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 LYTTON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1536
Mailing Address - Country:US
Mailing Address - Phone:408-761-5023
Mailing Address - Fax:408-228-0608
Practice Address - Street 1:280 LYTTON AVE. SUITE 1
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301
Practice Address - Country:US
Practice Address - Phone:408-761-5023
Practice Address - Fax:408-761-5023
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2456174400000X
CA7620237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist