Basic Information
| Provider Information | |||||||||
| NPI: | 1033174495 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALCALDE | ||||||||
| FirstName: | RENATO | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 19249 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322459249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047431883 | ||||||||
| FaxNumber: | 9046952465 | ||||||||
| Practice Location | |||||||||
| Address1: | 3333 W 20TH ST | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322541703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046959145 | ||||||||
| FaxNumber: | 9046952465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 02/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | ME30161 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 038150100 | 05 | FL | MEDICAID | 605640700 | 01 | ACS | OTHER | ME30161 | 01 | FL | PROFESSIONAL LICENSE | OTHER |