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NPI Code Detail

MEDICARE: RENAISSANCE FAMILY PRACTICE, UPMC

MEDICARE: RENAISSANCE FAMILY PRACTICE, UPMC
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
1332900000XNon-Pharmacy Dispensing SiteMD018049EPA

General Provider Information

NPI Number : 1568504728
Entity Type Code : Organization
Provider Name (Legal Business Name) : RENAISSANCE FAMILY PRACTICE, UPMC
Provider Business Mailing Address
First Line : 5626 OBERLIN DR
Second Line : SUITE 110
City : SAN DIEGO
State : CA
Zip : 92121-1705
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 111 SHERIDAN ST
Second Line :
City : PITTSBURGH
State : PA
Zip : 15209-2639
Country : US
Telephone Number : 412-821-2277
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF OPERATIONS
Name : KENNY HEINE
Credential :
Telephone Number : 858-625-2990
Provider Enumeration Date : 02/13/2007
Last Update Date : 10/17/2012

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Directions to “RENAISSANCE FAMILY PRACTICE, UPMC ” Practice Location

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