Healthcare Provider Details

I. General information

NPI: 1063380830
Provider Name (Legal Business Name): RENEWED LIFE REHAB AND PAIN SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 10/24/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2349 MAIN ST
BATAVIA IL
60510
US

IV. Provider business mailing address

4166 AMBERGRIS DR APT 111
LUTZ FL
33559-6938
US

V. Phone/Fax

Practice location:
  • Phone: 331-232-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: LORENZO J DIAZ
Title or Position: SOLE MBR
Credential: DO
Phone: 941-961-8870