Provider Demographics
NPI:1124776315
Name:GALACE, RENEE ELAINE MARINAS
Entity type:Individual
Prefix:MS
First Name:RENEE ELAINE
Middle Name:MARINAS
Last Name:GALACE
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:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-0036
Mailing Address - Country:US
Mailing Address - Phone:956-437-4442
Mailing Address - Fax:
Practice Address - Street 1:2891 E GRANT ST
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584-9170
Practice Address - Country:US
Practice Address - Phone:956-487-0846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1035032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily