Provider Demographics
NPI:1891263000
Name:RENOVA INTERNAL MEDICINE
Entity Type:Organization
Organization Name:RENOVA INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:YAZMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-877-1529
Mailing Address - Street 1:710 DENBIGH BLVD STE 7B
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4427
Mailing Address - Country:US
Mailing Address - Phone:757-877-1529
Mailing Address - Fax:757-877-2874
Practice Address - Street 1:710 DENBIGH BLVD STE 7B
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4427
Practice Address - Country:US
Practice Address - Phone:757-877-1529
Practice Address - Fax:757-877-2874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty