Provider Demographics
NPI:1003014432
Name:DIFUNTORUM, RENEE ANN
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ANN
Last Name:DIFUNTORUM
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 1:1260 FULTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-7396
Mailing Address - Country:US
Mailing Address - Phone:916-283-8280
Mailing Address - Fax:916-283-8259
Practice Address - Street 1:1260 FULTON AVE STE B
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-7396
Practice Address - Country:US
Practice Address - Phone:916-283-8280
Practice Address - Fax:916-283-8259
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator