Healthcare Provider Details

I. General information

NPI: 1689934572
Provider Name (Legal Business Name): JAMES FREDERICK RENDO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 S 5600 W SUITE B
WEST VALLEY CITY UT
84120-1249
US

IV. Provider business mailing address

2750 S 5600 W SUITE B
WEST VALLEY CITY UT
84120-1249
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax: 801-584-1276
Mailing address:
  • Phone: 801-582-1565
  • Fax: 801-584-1276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number7946683-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: