Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner |
NPI | 1023205861 |
---|---|
Provider Name | Albert De Leon Renovato |
First Address | San Bernardino, CA 92408-3243 |
Second Address | San Bernardino, CA 92408-3243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2007 |
Last Update Date | 25/02/2020 |