Provider Demographics
NPI:1619963741
Name:RENEE M. DUPONT, MD, INC
Entity Type:Organization
Organization Name:RENEE M. DUPONT, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPONT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-635-5631
Mailing Address - Street 1:1011 DEVONSHIRE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5136
Mailing Address - Country:US
Mailing Address - Phone:760-635-5631
Mailing Address - Fax:
Practice Address - Street 1:1011 DEVONSHIRE DR
Practice Address - Street 2:SUITE D
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5136
Practice Address - Country:US
Practice Address - Phone:760-635-5631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA192452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18982Medicare ID - Type Unspecified