Healthcare Provider Details

I. General information

NPI: 1275601684
Provider Name (Legal Business Name): RENEE PARNELL MCLEOD DNSC, APRN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 5TH AVE
SAN DIEGO CA
92103-2106
US

IV. Provider business mailing address

14452 CORTE MOREA
SAN DIEGO CA
92129-3812
US

V. Phone/Fax

Practice location:
  • Phone: 619-260-7278
  • Fax: 619-260-7310
Mailing address:
  • Phone: 858-484-8210
  • Fax: 858-484-3966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number272669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: