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General NPI Number Information
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NPI Number | 1295551133
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Entity Type | Organization
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Legal Business Name | RENOVATIO MEDICAL
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 9303 PINECROFT DR STE 250
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City | THE WOODLANDS
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State | TX
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Zip | 77380-3183
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Country | US
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Telephone | 936-444-4884
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Fax |
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Provider Business Mailing Address
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Address Line | 9303 PINECROFT DR STE 250
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City | THE WOODLANDS
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State | TX
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Zip | 77380-3183
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TALAL KAYYAL
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Credential |
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Telephone | 713-703-2398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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