Provider Demographics
NPI:1518389741
Name:RENE, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:RENE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 784806
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34778-4806
Mailing Address - Country:US
Mailing Address - Phone:321-662-0040
Mailing Address - Fax:407-517-4414
Practice Address - Street 1:651 REGINA CIR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:FL
Practice Address - Zip Code:34787-8962
Practice Address - Country:US
Practice Address - Phone:321-662-0040
Practice Address - Fax:407-517-4414
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906649311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home