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General NPI Number Information
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NPI Number | 1952335903
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Entity Type | Organization
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Legal Business Name | MARCO A. RENAZCO, M.D., P.A.
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 707 S FRY RD SUITE 465
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City | KATY
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State | TX
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Zip | 77450-2256
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Country | US
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Telephone | 281-599-3313
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Fax | 281-599-3363
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Provider Business Mailing Address
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Address Line | 707 S FRY RD SUITE 465
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City | KATY
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State | TX
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Zip | 77450-2256
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Country | US
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Telephone | 281-599-3313
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Fax | 281-599-3363
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARCO ANTONIO RENAZCO
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Credential | M.D.
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Telephone | 281-599-3313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | L1976
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License Number State | TX
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