Provider Demographics
NPI:1093791667
Name:PULLENS, RENITA JEJUAN (DO)
Entity Type:Individual
Prefix:
First Name:RENITA
Middle Name:JEJUAN
Last Name:PULLENS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23622 CALABASAS RD
Mailing Address - Street 2:STE 250
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1549
Mailing Address - Country:US
Mailing Address - Phone:818-591-3435
Mailing Address - Fax:
Practice Address - Street 1:15315 MAGNOLIA BLVD.
Practice Address - Street 2:ROZE ROOM HOSPICE OF THE VALLEY
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-783-1002
Practice Address - Fax:818-783-1066
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8326208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice