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General NPI Number Information
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NPI Number | 1730397555
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Entity Type | Organization
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Legal Business Name | NORTH GENERAL CENTER OF MEDICINE
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 1325 S CONGRESS AVE STE 101
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-5802
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Country | US
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Telephone | 561-733-2929
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Fax | 561-736-8467
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Provider Business Mailing Address
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Address Line | 1325 S CONGRESS AVE
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-5876
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Country | US
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Telephone | 561-733-2929
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Fax | 561-736-8467
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEAN LAVENTURE RENELIEN
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Credential | M.D
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Telephone | 561-414-6248
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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 | ME86189
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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