Provider Demographics
NPI:1457688178
Name:RANOLA, RENATO TORRES (SA-C)
Entity Type:Individual
Prefix:
First Name:RENATO
Middle Name:TORRES
Last Name:RANOLA
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 E ELLIS DR
Mailing Address - Street 2:CONTINENTAL VILLAS EAST III
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7426
Mailing Address - Country:US
Mailing Address - Phone:480-966-0237
Mailing Address - Fax:480-966-0237
Practice Address - Street 1:2106 E ELLIS DR
Practice Address - Street 2:CONTINENTAL VILLAS EAST III
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7426
Practice Address - Country:US
Practice Address - Phone:480-966-0237
Practice Address - Fax:480-966-0237
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO09-162246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant