MEDICARE: RENELLIE DEBELEN-GONZALES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	27259	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194780627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENELLIE DEBELEN-GONZALES MD

Provider Business Mailing Address
First Line	:	2851 S AVE B STE 32
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-7726
Country	:	US
Telephone Number	:	928-783-5828
Fax Number	:	928-373-9699

Provider Business Practice Location Address
First Line	:	2851 S AVE B STE 32
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-7726
Country	:	US
Telephone Number	:	928-783-5828
Fax Number	:	928-373-9699

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	07/29/2011

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