Healthcare Provider Details

I. General information

NPI: 1205919008
Provider Name (Legal Business Name): DR. DIOKSON RENA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SUTTER ST STE 320
SAN FRANCISCO CA
94102-1120
US

IV. Provider business mailing address

500 SUTTER ST STE 320
SAN FRANCISCO CA
94102-1120
US

V. Phone/Fax

Practice location:
  • Phone: 415-757-0814
  • Fax: 415-757-0820
Mailing address:
  • Phone: 415-757-0814
  • Fax: 415-757-0820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberC51983
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberC51983
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberC51983
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberC51983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: