Provider Demographics
NPI:1154436707
Name:DUA, RENEE (MD)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:DUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8349 RESEDA BLVD
Mailing Address - Street 2:STE G
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4622
Mailing Address - Country:US
Mailing Address - Phone:818-886-7300
Mailing Address - Fax:818-886-8786
Practice Address - Street 1:8349 RESEDA BLVD
Practice Address - Street 2:STE G
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4622
Practice Address - Country:US
Practice Address - Phone:818-886-7300
Practice Address - Fax:818-886-8786
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA78217174400000X, 174400000X
NY292538207R00000X, 207RN0300X, 208D00000X
NJ25MA10666300207R00000X, 207RN0300X, 208D00000X
NC2020-04368207R00000X
FLME141765207R00000X, 207RN0300X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A782170Medicaid
CA00A782170Medicaid