Healthcare Provider Details

I. General information

NPI: 1174213714
Provider Name (Legal Business Name): RENE RESENDEZ RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15809 BEAR CREEK PKWY STE 100
REDMOND WA
98052-1542
US

IV. Provider business mailing address

15809 BEAR CREEK PKWY STE 100
REDMOND WA
98052-1542
US

V. Phone/Fax

Practice location:
  • Phone: 425-882-6100
  • Fax:
Mailing address:
  • Phone: 425-882-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.MD.70158090
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: