Provider Demographics
NPI:1902986573
Name:RENATO R ALCALDE MD ABPN LLC
Entity Type:Organization
Organization Name:RENATO R ALCALDE MD ABPN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENATO
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALCALDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-398-3237
Mailing Address - Street 1:PO BOX 880746
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34988
Mailing Address - Country:US
Mailing Address - Phone:772-398-3237
Mailing Address - Fax:772-335-4734
Practice Address - Street 1:1881 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952
Practice Address - Country:US
Practice Address - Phone:772-398-3237
Practice Address - Fax:772-335-4734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME301612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00218464OtherRAILROAD MEDICARE
D55884Medicare UPIN
FLK7714Medicare ID - Type Unspecified