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General NPI Number Information
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NPI Number | 1952464745
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Entity Type | Organization
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Legal Business Name | RENATO G JUDALENA M.D. INC.
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2390 E FLORIDA AVE # 104
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City | HEMET
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State | CA
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Zip | 92544-4707
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Country | US
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Telephone | 951-492-0900
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Fax | 951-492-0985
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Provider Business Mailing Address
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Address Line | PO BOX 700
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City | HEMET
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State | CA
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Zip | 92546-0700
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Country | US
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Telephone | 951-492-0900
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Fax | 951-492-0985
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Authorized Official
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Title or Position | PRESIDENT
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Name | RENATO G JUDALENA
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Credential | M.D.
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Telephone | 951-492-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | C39765
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License Number State | CA
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