Healthcare Provider Details

I. General information

NPI: 1255606992
Provider Name (Legal Business Name): JEAN RENAUD FENELON RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 NW 210TH ST APT 203
MIAMI FL
33169-7003
US

IV. Provider business mailing address

880 NW 210TH ST APT 203
MIAMI FL
33169-7003
US

V. Phone/Fax

Practice location:
  • Phone: 786-263-8355
  • Fax:
Mailing address:
  • Phone: 786-263-8355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License NumberRT 11579
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: