Healthcare Provider Details

I. General information

NPI: 1295542207
Provider Name (Legal Business Name): RENUANCE COSMETIC SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24687 MONROE AVE
MURRIETA CA
92562-9591
US

IV. Provider business mailing address

24687 MONROE AVE
MURRIETA CA
92562-9591
US

V. Phone/Fax

Practice location:
  • Phone: 951-506-1040
  • Fax: 951-506-1044
Mailing address:
  • Phone: 951-506-1040
  • Fax: 951-506-1044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELENA SERDA
Title or Position: DIRECTOR
Credential:
Phone: 951-506-1040