Renegadexbio, PBC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

RENEGADEXBIO, PBC

Practice address

829 Heinz Ave
Berkeley, CA 94710-2754

Phone

(415) 338-9306

Fax

(415) 329-7843

NPI assigned

May 21, 2020

Organization subpart

No

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

Authorized official

Name

Craig Rouskey, MS

Title

Ceo

Phone

(415) 338-9306

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Renegade.Bio Doing business as

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Bay Area PL Services

  • Clinical Medical Laboratory
  • San Bruno, CA
  • NPI 1972088581

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Salustiano Ribeiro

  • Phlebotomy Technician
  • San Francisco, CA
  • NPI 1609351212
  NPD

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

{
    "created_epoch": "1590019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655251200000",
    "number": "1083237374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "829 HEINZ AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947102754",
            "telephone_number": "415-338-9306",
            "fax_number": "415-329-7843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 HEINZ AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947102754",
            "telephone_number": "415-338-9306",
            "fax_number": "415-329-7843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEGADEXBIO, PBC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-21",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A",
        "authorized_official_last_name": "ROUSKEY",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "415-338-9306",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE ID",
            "identifier": "CDF-90000924",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D2185960",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renegade.Bio",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Renegade.Bio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Helmut Relinger, PHD
• James Lawrence Rembert, MD
• Mary E. Remington, LMFT
• Ilan Zalel Remler, M.D.
• David M. Rempel, MD
• Alyssa Renfrew
• Rebecca Reno, LCSW
• Lindsay Loreto Renterias, MS, LAT, ATC
• Resilient Children Behavioral Health Center
• Angela Adalgisa Resina, NC, ONC

• Clinical Medical Laboratory in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.