Provider Demographics
NPI:1093499428
Name:PRESENCE TELEHEALTH PLLC
Entity Type:Organization
Organization Name:PRESENCE TELEHEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:COOPER
Authorized Official - Middle Name:L
Authorized Official - Last Name:RENDON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:805-698-8480
Mailing Address - Street 1:1030 BLUE GENTIAN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1961
Mailing Address - Country:US
Mailing Address - Phone:651-249-1308
Mailing Address - Fax:
Practice Address - Street 1:1030 BLUE GENTIAN RD STE 300
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1961
Practice Address - Country:US
Practice Address - Phone:651-249-1308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESENCE TELEHEALTH PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care