Provider Demographics
NPI:1922785690
Name:RENEWED MEDICAL GROUP, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RENEWED MEDICAL GROUP, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:RENEWED MENTAL HEALTH AND WELLNESS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MEDARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-361-0898
Mailing Address - Street 1:6816 E. KATELLA RD #1065
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5618
Mailing Address - Country:US
Mailing Address - Phone:714-831-0821
Mailing Address - Fax:714-276-2604
Practice Address - Street 1:421 N BROOKHURST ST STE 128
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5618
Practice Address - Country:US
Practice Address - Phone:714-361-0898
Practice Address - Fax:714-276-2604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty