Healthcare Provider Details

I. General information

NPI: 1669303459
Provider Name (Legal Business Name): RENOVA TELEMED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BARRIO TORRECILLA ALTA CALLE 5 #112 SECTOR VILLA SANTA
CANOVANAS PR
00729
US

IV. Provider business mailing address

7380 SW 60TH ST
OCALA FL
34474-2054
US

V. Phone/Fax

Practice location:
  • Phone: 352-657-4058
  • Fax:
Mailing address:
  • Phone: 352-657-4058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DANELIS PRISCILLA AYALA CARRASQUILLO
Title or Position: OWNER
Credential: MD
Phone: 787-225-0890