Provider Demographics
NPI:1407870736
Name:RENTA, ALEXIS RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:RAFAEL
Last Name:RENTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33425-0039
Mailing Address - Country:US
Mailing Address - Phone:561-369-7644
Mailing Address - Fax:561-369-3471
Practice Address - Street 1:2828 S SEACREST BLVD STE 211
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435
Practice Address - Country:US
Practice Address - Phone:561-369-7644
Practice Address - Fax:561-369-3471
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073546207LP2900X
FLME735462084A0401X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1407870736OtherUNITED HEALTH CARE
G67916Medicare UPIN