Provider Demographics
NPI:1912381724
Name:BELOUCHE, RENATO
Entity Type:Individual
Prefix:MR
First Name:RENATO
Middle Name:
Last Name:BELOUCHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3780 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4855
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3780 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE E
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-4855
Practice Address - Country:US
Practice Address - Phone:770-798-9799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN250155163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse