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General NPI Number Information
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NPI Number | 1538323027
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Entity Type | Organization
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Legal Business Name | REN HEALTHCARE
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 5955 MIRA MESA BLVD SUITE C
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City | SAN DIEGO
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State | CA
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Zip | 92121-4304
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Country | US
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Telephone | 858-784-0500
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Fax | 858-876-1529
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Provider Business Mailing Address
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Address Line | 5955 MIRA MESA BLVD SUITE C
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City | SAN DIEGO
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State | CA
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Zip | 92121-4304
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Country | US
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Telephone | 858-784-0500
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Fax | 858-876-1529
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | ERIC PAN
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Credential | M.D.
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Telephone | 858-784-0500
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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 | 2436801
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License Number State | CA
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