Healthcare Provider Details

I. General information

NPI: 1275642910
Provider Name (Legal Business Name): ELISABETH HARRIET RENNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5161 CLAYTON RD STE F
CONCORD CA
94521
US

IV. Provider business mailing address

1450 TREAT BLVD # 300
WALNUT CREEK CA
94597-2168
US

V. Phone/Fax

Practice location:
  • Phone: 925-609-8282
  • Fax:
Mailing address:
  • Phone: 925-952-2888
  • Fax: 925-687-5091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG66708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: