Provider Demographics
NPI:1932497583
Name:RENAUD, MOJKA (AP)
Entity Type:Individual
Prefix:
First Name:MOJKA
Middle Name:
Last Name:RENAUD
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 PRIMERA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2173
Mailing Address - Country:US
Mailing Address - Phone:407-617-0238
Mailing Address - Fax:
Practice Address - Street 1:635 PRIMERA BLVD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2173
Practice Address - Country:US
Practice Address - Phone:407-617-0238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2157171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist