MEDICARE: MR. VICTOR MANUEL RENDON

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	183700000X	Pharmacy Technician	5052	CA

General Provider Information

NPI Number	:	1942473665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VICTOR MANUEL RENDON

Provider Business Mailing Address
First Line	:	1633 GREMLINWAY
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977
Country	:	US
Telephone Number	:	619-713-6514
Fax Number	:

Provider Business Practice Location Address
First Line	:	1633 GREMLIN WAY
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977
Country	:	US
Telephone Number	:	619-713-6514
Fax Number	:	866-380-1013

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

Provider Enumeration Date	:	04/03/2008
Last Update Date	:	10/08/2009

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