Albert De Leon Renovato, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

90537 Issued in CA

Practice address

325 W Hospitality LN
San Bernardino, CA 92408-3243

Phone

(909) 427-5000

NPI assigned

Sep 25, 2007

Last updated

Feb 25, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Riverside, CA
  • NPI 1316979834
  Medicare reassignment NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582588800000",
    "number": "1023205861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 W HOSPITALITY LN",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083243",
            "telephone_number": "909-427-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 W HOSPITALITY LN",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083243",
            "telephone_number": "909-427-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1160 S Grand Ave",
            "address_purpose": "LOCATION",
            "city": "Glendora",
            "state": "CA",
            "postal_code": "917405000",
            "country_code": "US",
            "telephone_number": "626-335-5980",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RENOVATO",
        "first_name": "ALBERT",
        "middle_name": "DE LEON",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-25",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "90537",
            "primary": true
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renaissance Radiology Medical Group, Inc
• Renaissance Radiology Medical Group, Inc.
• Renal Treatment Centers California Inc (Citrus Valley Dialysis)
• Renal Treatment Centers California Inc (Mountain Vista Dialysis Center)
• Renewed Impressions of Life LLC
• Serissa Renteria
• Rescue Her
• Katelynn Christine Resendiz, PA-C
• Resilience Wellness Companions, LLC
• Resilient Healthcare Solutions LLC (Four Hearts Healthcare of California)

• Marriage & Family Therapist in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.