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General NPI Number Information
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NPI Number | 1629894324
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Entity Type | Organization
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Legal Business Name | RENEW HEALTH MEDICAL CORPORATION
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 30230 RANCHO VIEJO RD STE 134
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1585
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Country | US
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Telephone | 949-503-1414
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Fax |
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Provider Business Mailing Address
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Address Line | 146 SPUR ST
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City | RANCHO MISSION VIEJO
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State | CA
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Zip | 92694-1614
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Country | US
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Telephone | 949-702-6736
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TANYA DALL
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Credential | MD
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Telephone | 949-702-6736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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