# RENOVA CORP. CSP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043679236
- **Authorized official:** DR. JANICE MARIE RODRIGUEZ MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (787) 412-7009

## Contact information

- **Practice address:** CARR 2 KM 141.1 AVE SEVEREANO CUEVAS \#18, WESTERN MEDICAL PLAZA 1ST FLOOR SUITE \# 24, AGUADILLA, PR 00605
- **Practice address phone:** (787) 412-7009
- **Practice address fax:** (787) 919-0644
- **Mailing address:** CARR 2 KM 141.1 AVE SEVEREANO CUEVAS \#18, WESTERN MEDICAL PLAZA 1ST FLOOR SUITE 24 AGUADILLA, AGUADILLA, PR 00605
- **Mailing address phone:** (787) 412-7009
- **Mailing address fax:** (787) 919-0644

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 17029 | PR | Yes |

## Other

- **Enumeration date:** 02/16/2016
- **Last updated:** 02/16/2016