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General NPI Number Information
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NPI Number | 1184011496
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Entity Type | Organization
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Legal Business Name | ST JUDE PAIN AND REHABILITATION SPECIALISTS
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Dates
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Enumeration Date | 04/24/2015
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Last Update Date | 07/09/2018
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Provider Practice Location Address
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Address Line | 2828 S SEACREST BLVD STE 211
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City | BOYNTON BEACH
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State | FL
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Zip | 33435
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Country | US
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Telephone | 561-369-7644
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Fax | 561-369-3471
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Provider Business Mailing Address
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Address Line | 1308 LAKE DR
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City | DELRAY BEACH
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State | FL
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Zip | 33444-3046
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Country | US
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Telephone | 561-722-3388
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ALEXIS R RENTA
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Credential | M.D.
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Telephone | 561-722-3388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | ME73546
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | ME73546
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License Number State | FL
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