Provider Demographics
NPI:1447368683
Name:RENTA EMMANUELLI, EDUARDO (MD)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:
Last Name:RENTA EMMANUELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 330043
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-0043
Mailing Address - Country:US
Mailing Address - Phone:787-842-2013
Mailing Address - Fax:787-842-2013
Practice Address - Street 1:8104 CALLE CONCORDIA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1541
Practice Address - Country:US
Practice Address - Phone:787-842-2013
Practice Address - Fax:787-842-2013
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7669208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR825224OtherMMM HEALTHCARE
PR067304OtherCRUZ AZUL
PR2835OtherINTERNATIONAL MEDICAL CAR
PR7330012OtherHUMANA INSURANCE
PR27477OtherTRIPLE S
PR27477OtherTRIPLE S
PRC79663Medicare UPIN