Provider Demographics
NPI:1083934152
Name:RENTA, LYNETTE (4306)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:RENTA
Suffix:
Gender:F
Credentials:4306
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CALLE CENTRAL
Mailing Address - Street 2:LOCAL 1
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2139
Mailing Address - Country:US
Mailing Address - Phone:787-259-0233
Mailing Address - Fax:787-848-7117
Practice Address - Street 1:85 CALLE CENTRAL
Practice Address - Street 2:LOCAL 1
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2139
Practice Address - Country:US
Practice Address - Phone:787-259-0233
Practice Address - Fax:787-848-7117
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4306183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician