Provider Demographics
NPI:1437995057
Name:RENDEROS, MARIA RAQUEL
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:RAQUEL
Last Name:RENDEROS
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 1:12027 REID CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CA
Mailing Address - Zip Code:95386-9340
Mailing Address - Country:US
Mailing Address - Phone:925-695-5198
Mailing Address - Fax:
Practice Address - Street 1:12027 REID CT
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CA
Practice Address - Zip Code:95386-9340
Practice Address - Country:US
Practice Address - Phone:925-695-5198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504700038374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide