Healthcare Provider Details

I. General information

NPI: 1669439733
Provider Name (Legal Business Name): CHARLES JOSEPH RENNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5161 CLAYTON ROAD SUITE C
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: 925-687-2200
  • Fax: 925-689-5608
Mailing address:
  • Phone: 925-952-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG67128
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: