Provider Demographics
NPI:1114068004
Name:RENAISSANCE HOSPITAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:RENAISSANCE HOSPITAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUILLAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-798-9800
Mailing Address - Street 1:3420 FAIRLANE FARMS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8701
Mailing Address - Country:US
Mailing Address - Phone:561-798-9800
Mailing Address - Fax:561-296-3456
Practice Address - Street 1:8660 W FLAGLER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2031
Practice Address - Country:US
Practice Address - Phone:561-798-9800
Practice Address - Fax:561-296-3456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty