Healthcare Provider Details

I. General information

NPI: 1952425951
Provider Name (Legal Business Name): HUMBERTO M RENDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HUMBERTO M RENDON M.D.

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4129 E INDIAN SCHOOL RD APT 422
PHOENIX AZ
85018-5388
US

IV. Provider business mailing address

4129 E INDIAN SCHOOL RD APT 422
PHOENIX AZ
85018-5388
US

V. Phone/Fax

Practice location:
  • Phone: 602-418-5669
  • Fax: 602-314-5729
Mailing address:
  • Phone: 602-418-5669
  • Fax: 602-314-5729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number16214
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: