Provider Demographics
NPI:1891468625
Name:RENACER MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:RENACER MEDICAL CENTER LLC
Other - Org Name:RENACER MEDICAL CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:GUITIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-905-0012
Mailing Address - Street 1:8300 W FLAGLER ST # 2541B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-6000
Mailing Address - Country:US
Mailing Address - Phone:305-905-0012
Mailing Address - Fax:
Practice Address - Street 1:395 SW 80TH AVE # 350
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2119
Practice Address - Country:US
Practice Address - Phone:786-336-0232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center