Healthcare Provider Details

I. General information

NPI: 1730397555
Provider Name (Legal Business Name): NORTH GENERAL CENTER OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S CONGRESS AVE STE 101
BOYNTON BEACH FL
33426-5802
US

IV. Provider business mailing address

1325 S CONGRESS AVE
BOYNTON BEACH FL
33426-5876
US

V. Phone/Fax

Practice location:
  • Phone: 561-733-2929
  • Fax: 561-736-8467
Mailing address:
  • Phone: 561-733-2929
  • Fax: 561-736-8467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME86189
License Number StateFL

VIII. Authorized Official

Name: DR. JEAN LAVENTURE RENELIEN
Title or Position: OWNER
Credential: M.D
Phone: 561-414-6248