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General NPI Number Information
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NPI Number | 1669303459
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Entity Type | Organization
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Legal Business Name | RENOVA TELEMED
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Dates
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Enumeration Date | 05/28/2026
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Last Update Date | 05/28/2026
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Provider Practice Location Address
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Address Line | BARRIO TORRECILLA ALTA CALLE 5 #112 SECTOR VILLA SANTA
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City | CANOVANAS
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State | PR
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Zip | 00729
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Country | US
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Telephone | 352-657-4058
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Fax |
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Provider Business Mailing Address
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Address Line | 7380 SW 60TH ST
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City | OCALA
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State | FL
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Zip | 34474-2054
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Country | US
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Telephone | 352-657-4058
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANELIS PRISCILLA AYALA CARRASQUILLO
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Credential | MD
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Telephone | 787-225-0890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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