Provider Demographics
NPI:1366959025
Name:RENOVATO, MARIBEL NAVARRO (CNA)
Entity type:Individual
Prefix:
First Name:MARIBEL
Middle Name:NAVARRO
Last Name:RENOVATO
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 LAWNMONT DR APT 111
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-6674
Mailing Address - Country:US
Mailing Address - Phone:915-850-8402
Mailing Address - Fax:
Practice Address - Street 1:1500 LAWNMONT DR APT 111
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6674
Practice Address - Country:US
Practice Address - Phone:915-850-8402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA0008463073376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty