MEDICARE: FERNANDO RENNELLA 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
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	ME 39507	FL

General Provider Information

NPI Number	:	1912951591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO RENNELLA M.D.

Provider Business Mailing Address
First Line	:	8188 JOG RD
Second Line	:	SUITE 102
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-2952
Country	:	US
Telephone Number	:	561-737-1947
Fax Number	:	561-737-9074

Provider Business Practice Location Address
First Line	:	8188 JOG RD
Second Line	:	SUITE 102
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-2952
Country	:	US
Telephone Number	:	561-737-1947
Fax Number	:	561-737-9074

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/08/2007

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