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Organization
RENEW PC
Active
Organization
RENEW PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TANYA DALL MD (OWNER)
(949) 702-6736
Entity
Organization
Contact information
Practice address
30230 RANCHO VIEJO RD STE 134, SAN JUAN CAPISTRANO, CA 92675-1585
(949) 478-1411
Mailing address
146 SPUR ST, RANCHO MISSION VIEJO, CA 92694-1614
(949) 702-6736
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235592478
—
CA
Enumeration date
11/21/2022
Last updated
12/04/2024
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