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NPI Code Detail

MEDICARE: DR. SHAWN RENNER PT

MEDICARE: DR. SHAWN RENNER PT
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
1208100000XPhysical Medicine & Rehabilitation Physician294323CA

General Provider Information

NPI Number : 1790283737
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHAWN RENNER PT
Provider Business Mailing Address
First Line : 6699 ALVARADO RD
Second Line : STE 2100
City : SAN DIEGO
State : CA
Zip : 92120-5238
Country : US
Telephone Number : 619-229-3929
Fax Number : 619-229-3902
Provider Business Practice Location Address
First Line : 1945 GARNET AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92109-3595
Country : US
Telephone Number : 858-224-7977
Fax Number : 858-224-7978
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2018
Last Update Date : 10/08/2019

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