1376922021 NPI number — STEWART ELVIS RENDON, M.D., INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376922021 NPI number — STEWART ELVIS RENDON, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEWART ELVIS RENDON, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376922021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11100 WARNER AVE
Provider Second Line Business Mailing Address:
SUITE 258
Provider Business Mailing Address City Name:
FOUNTAIN VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92708-7506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-549-5990
Provider Business Mailing Address Fax Number:
714-845-0041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11100 WARNER AVE
Provider Second Line Business Practice Location Address:
SUITE 258
Provider Business Practice Location Address City Name:
FOUNTAIN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92708-7506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-549-5990
Provider Business Practice Location Address Fax Number:
714-845-0041
Provider Enumeration Date:
05/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
RENDON
Authorized Official First Name:
STEWART
Authorized Official Middle Name:
ELVIS
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
646-554-4491

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  A78664 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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