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NPI Code Detail

MEDICARE: RENOLD CHARLES

MEDICARE: RENOLD CHARLES
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
1363A00000XPhysician Assistant1745P.A.PR

General Provider Information

NPI Number : 1538931290
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENOLD CHARLES
Provider Business Mailing Address
First Line : 101 NE 31ST ST
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33064-3645
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4405 LAKEWOOD RD
Second Line :
City : LAKE WORTH
State : FL
Zip : 33461-3414
Country : US
Telephone Number : 561-969-1400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2023
Last Update Date : 10/26/2023

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Directions to “ RENOLD CHARLES ” Practice Location

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