Healthcare Provider Details

I. General information

NPI: 1568561165
Provider Name (Legal Business Name): RENDOLL CONCEPCION M.D, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 E ALLUVIAL AVE STE 101
FRESNO CA
93720-3857
US

IV. Provider business mailing address

1885 E ALLUVIAL AVE STE 101
FRESNO CA
93720-3857
US

V. Phone/Fax

Practice location:
  • Phone: 559-298-9032
  • Fax:
Mailing address:
  • Phone: 559-298-9032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: RENDOLL CONCEPCION
Title or Position: OWNER
Credential:
Phone: 559-298-9032