Provider Demographics
NPI:1003425653
Name:RNDIVAS RC
Entity Type:Organization
Organization Name:RNDIVAS RC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENEYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:469-835-4911
Mailing Address - Street 1:3106 GLADIOLUS LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75233-3910
Mailing Address - Country:US
Mailing Address - Phone:469-835-4911
Mailing Address - Fax:
Practice Address - Street 1:3106 GLADIOLUS LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75233-3910
Practice Address - Country:US
Practice Address - Phone:469-835-4911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RN MEDICAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty