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General NPI Number Information
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NPI Number | 1710650882
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Entity Type | Organization
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Legal Business Name | RENU WELLNESS CENTERS, LLC.
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Dates
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Enumeration Date | 07/26/2021
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 8839 BRYAN DAIRY RD STE 215
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City | LARGO
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State | FL
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Zip | 33777-1207
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Country | US
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Telephone | 727-851-9804
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 VALLEY FORGE RD STE 23
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City | PHOENIXVILLE
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State | PA
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Zip | 19460-2676
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Country | US
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Telephone | 832-549-2941
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Fax |
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Authorized Official
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Title or Position | CORPORATE MANAGEMENT
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Name | MONICA RUBIO
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Credential |
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Telephone | 832-549-2941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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