Provider Demographics
NPI:1083722243
Name:RADENTZ, WILLIAM HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HENRY
Last Name:RADENTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:39755 MURRIETA HOT SPRINGS RD
Mailing Address - Street 2:A130
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563
Mailing Address - Country:US
Mailing Address - Phone:951-600-3946
Mailing Address - Fax:951-304-2203
Practice Address - Street 1:39755 MURRIETA HOT SPRINGS RD
Practice Address - Street 2:A130
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563
Practice Address - Country:US
Practice Address - Phone:951-600-3946
Practice Address - Fax:951-304-2203
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50446207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOC504460Medicare ID - Type Unspecified