Provider Demographics
NPI:1144402306
Name:JEAN-LOUIS LE RENARD, M.D. INC.
Entity Type:Organization
Organization Name:JEAN-LOUIS LE RENARD, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN-LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LE RENARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-472-6750
Mailing Address - Street 1:PO BOX 49841
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-0841
Mailing Address - Country:US
Mailing Address - Phone:310-472-6750
Mailing Address - Fax:310-471-9433
Practice Address - Street 1:153 GRANVILLE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-4224
Practice Address - Country:US
Practice Address - Phone:310-472-6750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA246612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A246610Medicaid
W6530OtherMEDICARE GROUP
W6530OtherMEDICARE GROUP
CA00A246610Medicaid