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General NPI Number Information
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NPI Number | 1063230035
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Entity Type | Organization
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Legal Business Name | RENEW DERMATOLOGY
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 7325 W DESCHUTES AVE STE D
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City | KENNEWICK
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State | WA
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Zip | 99336-6705
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Country | US
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Telephone | 509-940-3376
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Fax |
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Provider Business Mailing Address
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Address Line | 7325 W DESCHUTES AVE STE D
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City | KENNEWICK
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State | WA
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Zip | 99336-6705
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Country | US
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Telephone | 509-940-3376
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JAMESA CASTILLA
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Credential |
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Telephone | 509-940-3376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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