Provider Demographics
NPI:1043041049
Name:RENTERIA, ANGELINA MONIQUE
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:MONIQUE
Last Name:RENTERIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 S GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4949
Mailing Address - Country:US
Mailing Address - Phone:559-467-6704
Mailing Address - Fax:
Practice Address - Street 1:1627 S GARDEN ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4949
Practice Address - Country:US
Practice Address - Phone:559-467-6704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator