Healthcare Provider Details

I. General information

NPI: 1295843092
Provider Name (Legal Business Name): JOEL WILLIAM RENBAUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DANIEL BURNHAM CT SUITE 365C
SAN FRANCISCO CA
94109-5455
US

IV. Provider business mailing address

1 DANIEL BURNHAM CT SUITE 365C
SAN FRANCISCO CA
94109-5455
US

V. Phone/Fax

Practice location:
  • Phone: 415-409-7364
  • Fax: 415-409-0735
Mailing address:
  • Phone: 415-409-7364
  • Fax: 415-409-0735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG17949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: