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NPI Code Detail

MEDICARE: ORLANDO VILLLANUEVA RENDON M.D.

MEDICARE: ORLANDO VILLLANUEVA RENDON M.D.
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
1208000000XPediatrics PhysicianME72080FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700891595
Entity Type Code : Individual
Provider Name (Legal Business Name) : ORLANDO VILLLANUEVA RENDON M.D.
Provider Business Mailing Address
First Line : 8351 WESTPORT RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32244-5901
Country : US
Telephone Number : 904-317-8811
Fax Number : 904-317-4949
Provider Business Practice Location Address
First Line : 8351 WESTPORT RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32244-5901
Country : US
Telephone Number : 904-317-8811
Fax Number : 904-317-4949
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2006
Last Update Date : 08/12/2016

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