Healthcare Provider Details

I. General information

NPI: 1598452823
Provider Name (Legal Business Name): NICHOLAS ANTONY RENSING D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26671 ALISO CREEK RD STE 206
ALISO VIEJO CA
92656-4810
US

IV. Provider business mailing address

39000 BOB HOPE DRIVE ACHS-GME OFFICE STE. 201
RANCHO MIRAGE CA
92270
US

V. Phone/Fax

Practice location:
  • Phone: 949-791-3104
  • Fax: 949-791-3187
Mailing address:
  • Phone: 760-773-4504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A23207
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: