Provider Demographics
NPI:1871663765
Name:DIEPPA, RENAN A (MD)
Entity type:Individual
Prefix:DR
First Name:RENAN
Middle Name:A
Last Name:DIEPPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 363704
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3704
Mailing Address - Country:US
Mailing Address - Phone:787-751-3535
Mailing Address - Fax:787-767-6111
Practice Address - Street 1:982 S.E. 42ND STREET
Practice Address - Street 2:REPARTO METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-751-3535
Practice Address - Fax:787-767-6111
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR05711208800000X
PR57112088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE00145Medicare UPIN