Provider Demographics
NPI:1952425951
Name:RENDON, HUMBERTO M (MD)
Entity Type:Individual
Prefix:DR
First Name:HUMBERTO
Middle Name:M
Last Name:RENDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HUMBERTO
Other - Middle Name:M
Other - Last Name:RENDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4129 E INDIAN SCHOOL RD APT 422
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5388
Mailing Address - Country:US
Mailing Address - Phone:602-418-5669
Mailing Address - Fax:602-314-5729
Practice Address - Street 1:4129 E INDIAN SCHOOL RD APT 422
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5388
Practice Address - Country:US
Practice Address - Phone:602-418-5669
Practice Address - Fax:602-314-5729
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16214291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory