Healthcare Provider Details

I. General information

NPI: 1013384148
Provider Name (Legal Business Name): ALEX RENDA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 1ST ST SUITE 101
SAN FRANCISCO CA
94105-2636
US

IV. Provider business mailing address

PO BOX 1848
NOVATO CA
94948-1848
US

V. Phone/Fax

Practice location:
  • Phone: 415-892-7560
  • Fax:
Mailing address:
  • Phone: 415-892-7560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT42804
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: