Healthcare Provider Details

I. General information

NPI: 1487133781
Provider Name (Legal Business Name): REBECCA RENDON RN MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8610 N. NEW BRAUNFELS AVE STE. 405
SAN ANTONIO TX
78217
US

IV. Provider business mailing address

8610 N NEW BRAUNFELS AVE STE 500
SAN ANTONIO TX
78217-6397
US

V. Phone/Fax

Practice location:
  • Phone: 210-638-1604
  • Fax:
Mailing address:
  • Phone: 210-804-0193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number243724
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: