Provider Demographics
NPI:1275531337
Name:RENDLER, NATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:RENDLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15525 POMERADO ROAD #B1
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2425
Mailing Address - Country:US
Mailing Address - Phone:858-487-8333
Mailing Address - Fax:858-487-0856
Practice Address - Street 1:15525 POMERADO ROAD #B1
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2425
Practice Address - Country:US
Practice Address - Phone:858-487-8333
Practice Address - Fax:858-487-0856
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64231174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G642310Medicaid