Healthcare Provider Details

I. General information

NPI: 1184357972
Provider Name (Legal Business Name): JR RENAISSANCE HEALTH SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1957 HWAY 95 STE 23
BULLHEAD CITY AZ
86442-6744
US

IV. Provider business mailing address

PO BOX 90182
HENDERSON NV
89009-0182
US

V. Phone/Fax

Practice location:
  • Phone: 928-234-3834
  • Fax:
Mailing address:
  • Phone: 928-234-3834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RENE GONZALEZ GARCIA
Title or Position: MD CEO
Credential: MD
Phone: 928-293-5999