Provider Demographics
NPI:1265815278
Name:RENOVATION HEALTH MEDICAL CENTER INC
Entity Type:Organization
Organization Name:RENOVATION HEALTH MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YUNIER
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-720-9253
Mailing Address - Street 1:4355 W 16TH AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7666
Mailing Address - Country:US
Mailing Address - Phone:305-720-9253
Mailing Address - Fax:305-402-0422
Practice Address - Street 1:4355 W 16TH AVE STE 211
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7666
Practice Address - Country:US
Practice Address - Phone:305-720-9253
Practice Address - Fax:305-402-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty