Provider Demographics
NPI:1447997705
Name:RENDA, SERENA ROSE
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:ROSE
Last Name:RENDA
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 1:789 N MAIN ST STE 260
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-2487
Mailing Address - Country:US
Mailing Address - Phone:347-885-1469
Mailing Address - Fax:
Practice Address - Street 1:1360 N MAIN ST STE 124
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3013
Practice Address - Country:US
Practice Address - Phone:347-885-1469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist