Healthcare Provider Details

I. General information

NPI: 1407870736
Provider Name (Legal Business Name): ALEXIS RAFAEL RENTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 S SEACREST BLVD STE 211
BOYNTON BEACH FL
33435
US

IV. Provider business mailing address

PO BOX 39
BOYNTON BEACH FL
33425-0039
US

V. Phone/Fax

Practice location:
  • Phone: 561-369-7644
  • Fax: 561-369-3471
Mailing address:
  • Phone: 561-369-7644
  • Fax: 561-369-3471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME0073546
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberME73546
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME73546
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: