Provider Demographics
NPI:1669498655
Name:CONCEPCION, RENDOLL (MD)
Entity Type:Individual
Prefix:MR
First Name:RENDOLL
Middle Name:
Last Name:CONCEPCION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 E ALLUVIAL AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3854
Mailing Address - Country:US
Mailing Address - Phone:559-253-2800
Mailing Address - Fax:559-298-9061
Practice Address - Street 1:1885 E ALLUVIAL
Practice Address - Street 2:#101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-298-9031
Practice Address - Fax:559-298-9061
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39752208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F36836Medicare UPIN
CA00A397520Medicare ID - Type Unspecified