Healthcare Provider Details

I. General information

NPI: 1407718323
Provider Name (Legal Business Name): JORGE LUIS RESENDIZ BSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 POWER RD
CRANSTON RI
02920-3046
US

IV. Provider business mailing address

152 FINCH AVE
PAWTUCKET RI
02860-2418
US

V. Phone/Fax

Practice location:
  • Phone: 401-462-7234
  • Fax:
Mailing address:
  • Phone: 857-413-8128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN69709
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: