Provider Demographics
NPI:1063230035
Name:RENEW DERMATOLOGY
Entity type:Organization
Organization Name:RENEW DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMESA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-940-3376
Mailing Address - Street 1:7325 W DESCHUTES AVE STE D
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6705
Mailing Address - Country:US
Mailing Address - Phone:509-940-3376
Mailing Address - Fax:
Practice Address - Street 1:7325 W DESCHUTES AVE STE D
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6705
Practice Address - Country:US
Practice Address - Phone:509-940-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty