Provider Demographics
NPI:1013597129
Name:RENGGLI, DESIRE
Entity Type:Individual
Prefix:
First Name:DESIRE
Middle Name:
Last Name:RENGGLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 TROON OVERLOOK APT 101
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1452
Mailing Address - Country:US
Mailing Address - Phone:443-285-3591
Mailing Address - Fax:
Practice Address - Street 1:200 OLD COUNTRY RD STE 460
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4293
Practice Address - Country:US
Practice Address - Phone:516-663-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program