Healthcare Provider Details

I. General information

NPI: 1902882434
Provider Name (Legal Business Name): RENARD GARCIA SCOTT HS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 COAST GUARD BLVD MEDICAL DIVISION
PORTSMOUTH VA
23703-2135
US

IV. Provider business mailing address

4000 COAST GUARD BLVD MEDICAL DIVISION
PORTSMOUTH VA
23703-2135
US

V. Phone/Fax

Practice location:
  • Phone: 757-483-8597
  • Fax: 757-483-8610
Mailing address:
  • Phone: 757-483-8597
  • Fax: 757-483-8610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: