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General NPI Number Information
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NPI Number | 1922785690
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Entity Type | Organization
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Legal Business Name | RENEWED MEDICAL GROUP, A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/03/2023
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Last Update Date | 04/02/2024
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Provider Practice Location Address
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Address Line | 421 N BROOKHURST ST STE 128
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City | ANAHEIM
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State | CA
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Zip | 92801-5618
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Country | US
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Telephone | 714-361-0898
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Fax | 714-276-2604
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Provider Business Mailing Address
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Address Line | 6816 E. KATELLA RD #1065
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City | CYPRESS
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State | CA
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Zip | 90630-5618
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Country | US
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Telephone | 714-831-0821
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Fax | 714-276-2604
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Authorized Official
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Title or Position | CEO
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Name | MEDARD SISON
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Credential |
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Telephone | 714-361-0898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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