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General NPI Number Information
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NPI Number | 1134214109
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Entity Type | Individual
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Provider Name | CARMEN LUISA RENOVALES RPT
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 06/29/2009
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Provider Practice Location Address
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Address Line | CALLE 59 BLOQUE 71 #12 SIERRA BAYAMON
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City | BAYAMON
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State | PR
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Zip | 00961-0000
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Country | US
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Telephone | 787-565-4790
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Fax | 787-778-4294
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Provider Business Mailing Address
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Address Line | CALLE 59 BLOQUE 71 #12 SIERRA BAYAMON
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City | BAYAMON
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State | PR
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Zip | 00961-0000
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Country | US
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Telephone | 787-565-4790
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Fax | 787-778-4294
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 00623
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License Number State | PR
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