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NPI Code Detail

MEDICARE: GRISELDA LUZ RENEDO MD

MEDICARE: GRISELDA LUZ RENEDO MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician237244-1NY

General Provider Information

NPI Number : 1184757114
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRISELDA LUZ RENEDO MD
Provider Business Mailing Address
First Line : 2432 GRAND CONCOURSE
Second Line : SUITE 201
City : BRONX
State : NY
Zip : 10458-5204
Country : US
Telephone Number : 718-817-7061
Fax Number : 718-817-7067
Provider Business Practice Location Address
First Line : 2432 GRAND CONCOURSE
Second Line : SUITE 201
City : BRONX
State : NY
Zip : 10458-5204
Country : US
Telephone Number : 718-817-7061
Fax Number : 718-817-7067
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2007
Last Update Date : 07/19/2007

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