Basic Information
| Provider Information | |||||||||
| NPI: | 1750678231 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RENN | ||||||||
| FirstName: | CAITLIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7720 N FRESNO ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937202407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594382300 | ||||||||
| FaxNumber: | 5594381531 | ||||||||
| Practice Location | |||||||||
| Address1: | 4920 SO 30TH STREET | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681071656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027344110 | ||||||||
| FaxNumber: | 4027343990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2011 | ||||||||
| LastUpdateDate: | 10/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 6619 | NE | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | C169909 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.