Healthcare Provider Details

I. General information

NPI: 1235027293
Provider Name (Legal Business Name): RENOVA SPECIALTY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S SPALDING DR STE 300
BEVERLY HILLS CA
90212-1837
US

IV. Provider business mailing address

120 S SPALDING DR STE 300
BEVERLY HILLS CA
90212-1837
US

V. Phone/Fax

Practice location:
  • Phone: 615-499-3165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS JOKERST
Title or Position: AO
Credential:
Phone: 615-499-3165