Provider Demographics
NPI:1528768363
Name:RENAUD, EMILIE ALEXIA
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:ALEXIA
Last Name:RENAUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 MELODY LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-2920
Mailing Address - Country:US
Mailing Address - Phone:951-643-9408
Mailing Address - Fax:
Practice Address - Street 1:3815 MELODY LN
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-2920
Practice Address - Country:US
Practice Address - Phone:951-643-9408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer