Provider Demographics
NPI:1306960471
Name:RENATO CONCEPCION MD PA
Entity type:Organization
Organization Name:RENATO CONCEPCION MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRES
Authorized Official - Prefix:
Authorized Official - First Name:LEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONCEPCION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-936-7119
Mailing Address - Street 1:3709 W HAMILTON AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4015
Mailing Address - Country:US
Mailing Address - Phone:813-936-7119
Mailing Address - Fax:813-936-2317
Practice Address - Street 1:3709 W HAMILTON AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4015
Practice Address - Country:US
Practice Address - Phone:813-936-7119
Practice Address - Fax:813-936-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty