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General NPI Number Information
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NPI Number | 1326814070
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Entity Type | Organization
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Legal Business Name | RENEW WELLNESS CENTER
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Dates
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Enumeration Date | 12/04/2023
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 9 LAKE BELLEVUE DR STE 115
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City | BELLEVUE
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State | WA
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Zip | 98005-2454
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Country | US
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Telephone | 425-289-7805
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Fax |
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Provider Business Mailing Address
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Address Line | 9 LAKE BELLEVUE DR STE 115
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City | BELLEVUE
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State | WA
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Zip | 98005-2454
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Country | US
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Telephone | 425-289-7805
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | DR. SIMON KATUMU
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Credential | DNP
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Telephone | 314-398-4426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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