1144463456 NPI number — MISS OFELIA REOTAN RENTORIA RPH

Table of content: MISS OFELIA REOTAN RENTORIA RPH (NPI 1144463456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144463456 NPI number — MISS OFELIA REOTAN RENTORIA RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RENTORIA
Provider First Name:
OFELIA
Provider Middle Name:
REOTAN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144463456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2920 VISTA DEL MONTE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92882-6100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-818-4373
Provider Business Mailing Address Fax Number:
951-278-0749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26520 CACTUS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORENO VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92555-3927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-406-4501
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RPH45104 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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