Provider Demographics
NPI:1649278599
Name:MANAYAN, REX CHANG (MD)
Entity type:Individual
Prefix:DR
First Name:REX
Middle Name:CHANG
Last Name:MANAYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71780 SAN JACINTO DR BLDG I
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-5516
Mailing Address - Country:US
Mailing Address - Phone:760-568-3461
Mailing Address - Fax:760-423-6273
Practice Address - Street 1:3333 CONCOURS STE 100
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4875
Practice Address - Country:US
Practice Address - Phone:909-481-3242
Practice Address - Fax:909-481-3243
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2025-11-13
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-08-08
Provider Licenses
StateLicense IDTaxonomies
CAG86289208600000X
CODR.00592592086S0129X
AZ672092086S0129X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ154997Medicaid
CA00G862890Medicare ID - Type Unspecified
CA48570Medicare UPIN