Provider Demographics
NPI:1053067579
Name:JEAN-LOUIS, RENESON
Entity Type:Individual
Prefix:
First Name:RENESON
Middle Name:
Last Name:JEAN-LOUIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4523
Mailing Address - Country:US
Mailing Address - Phone:415-474-7310
Mailing Address - Fax:
Practice Address - Street 1:1663 MISSION ST STE 250
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2488
Practice Address - Country:US
Practice Address - Phone:415-465-9095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator