Provider Demographics
NPI:1033349691
Name:RENOVI CENTER FOR INTEGRATIVE MEDICINE AND ARTS, INC.
Entity Type:Organization
Organization Name:RENOVI CENTER FOR INTEGRATIVE MEDICINE AND ARTS, INC.
Other - Org Name:RENOVI CENTER FOR INTEGRATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:YEN
Authorized Official - Middle Name:INGRID
Authorized Official - Last Name:LAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-244-8902
Mailing Address - Street 1:310 N INDIAN HILL BLVD
Mailing Address - Street 2:#240
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 N INDIAN HILL BLVD
Practice Address - Street 2:#240
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4611
Practice Address - Country:US
Practice Address - Phone:909-244-8902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63942207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty