Provider Demographics
NPI:1427221126
Name:RENAUD, DAVID DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DALE
Last Name:RENAUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:20280 S VERMONT AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1370
Mailing Address - Country:US
Mailing Address - Phone:310-899-9793
Mailing Address - Fax:310-576-7708
Practice Address - Street 1:1450 10TH ST.
Practice Address - Street 2:#200
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401
Practice Address - Country:US
Practice Address - Phone:310-899-9793
Practice Address - Fax:310-576-7708
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2017-03-10
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Provider Licenses
StateLicense IDTaxonomies
CAA103161208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice