MEDICARE: RENEE STARK

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
1	133V00000X	Registered Dietitian	86020783	NV

General Provider Information

NPI Number	:	1326584632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE STARK

Provider Business Mailing Address
First Line	:	9131 PLACER BULLION AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-6200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9131 PLACER BULLION AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-6200
Country	:	US
Telephone Number	:	909-618-7393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2017
Last Update Date	:	12/16/2025

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Directions to “ RENEE STARK ” Practice Location

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