Provider Demographics
NPI:1124602552
Name:RENAISSANCE DX LLC
Entity type:Organization
Organization Name:RENAISSANCE DX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RONDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-221-5681
Mailing Address - Street 1:9830 S 51ST ST STE A124
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5672
Mailing Address - Country:US
Mailing Address - Phone:480-608-1730
Mailing Address - Fax:
Practice Address - Street 1:9830 S 51ST ST STE A124
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5672
Practice Address - Country:US
Practice Address - Phone:480-608-1730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory