Healthcare Provider Details

I. General information

NPI: 1669765251
Provider Name (Legal Business Name): RAYMOND R. RENDON & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 FOREST AVE STE 2
SAN JOSE CA
95128-1478
US

IV. Provider business mailing address

2120 FOREST AVE STE 2
SAN JOSE CA
95128-1478
US

V. Phone/Fax

Practice location:
  • Phone: 408-297-4850
  • Fax: 408-297-0676
Mailing address:
  • Phone: 408-297-4850
  • Fax: 408-297-0676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND R RENDON
Title or Position: OCULARIST
Credential: B.C.O
Phone: 408-297-4850