Provider Demographics
NPI:1891703062
Name:RENDON, NELLIE ESTHER (LMT)
Entity Type:Individual
Prefix:
First Name:NELLIE
Middle Name:ESTHER
Last Name:RENDON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:NELLIE
Other - Middle Name:E
Other - Last Name:RENDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:2774 POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-2153
Mailing Address - Country:US
Mailing Address - Phone:561-439-3262
Mailing Address - Fax:
Practice Address - Street 1:2072 S MILITARY TRL
Practice Address - Street 2:SUITE 7
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-6419
Practice Address - Country:US
Practice Address - Phone:561-965-5500
Practice Address - Fax:561-965-5592
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0012117174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist