Provider Demographics
NPI:1528543725
Name:RENAISSANCE REJUVENATING MEDICINE INC
Entity Type:Organization
Organization Name:RENAISSANCE REJUVENATING MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA BELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-800-3028
Mailing Address - Street 1:629 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-1971
Mailing Address - Country:US
Mailing Address - Phone:239-800-3028
Mailing Address - Fax:239-599-4893
Practice Address - Street 1:629 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-1971
Practice Address - Country:US
Practice Address - Phone:239-800-3028
Practice Address - Fax:239-599-4893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch