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General NPI Number Information
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NPI Number | 1841182979
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Entity Type | Organization
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Legal Business Name | RENAISSANCE MEDICAL AESTHETICS
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Dates
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Enumeration Date | 07/15/2025
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 11 SANDERSDALE RD # 15
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City | SOUTHBRIDGE
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State | MA
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Zip | 01550-2855
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Country | US
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Telephone | 774-371-4180
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Fax |
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Provider Business Mailing Address
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Address Line | 11 SANDERSDALE RD # 15
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City | SOUTHBRIDGE
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State | MA
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Zip | 01550-2855
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Country | US
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Telephone | 774-371-4180
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISSETTE I GUZMAN
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Credential |
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Telephone | 860-912-8738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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