Healthcare Provider Details

I. General information

NPI: 1811330103
Provider Name (Legal Business Name): GIA RENDON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 18TH ST SW STE 5
OWATONNA MN
55060-3982
US

IV. Provider business mailing address

9603 RICH VALLEY BLVD
INVER GROVE HEIGHTS MN
55077-4523
US

V. Phone/Fax

Practice location:
  • Phone: 507-413-0217
  • Fax: 949-882-2367
Mailing address:
  • Phone: 651-528-3400
  • Fax: 949-882-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number11635
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number11635
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number11635
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: