Renee Elaine Rose-Lynville, CAS
Individual provider Active NPI Specialist · Lotus, CA
NPI 1174969232 · NPPES record last updated May 16, 2013
Key facts
- NPI
- 1174969232
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 03042343 (CA)
- Practice address
- 838 Beach Court
Lotus, CA 95613 - Phone
- (530) 626-7252
- NPI assigned
- May 16, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03042343 | CA | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 03042343 | CA | Yes |
Addresses
Primary practice location
838 Beach Court
Lotus, CA 95613
Mailing address
P.O. Box 437
Coloma, CA 95613
Phone (530) 626-7252
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03042343 | Other | CA | CERTIFIED SPECIALIST |
Other providers in Lotus, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.