Provider Demographics
NPI:1225653298
Name:AHDUT, RENA AVITAL (DC)
Entity Type:Individual
Prefix:DR
First Name:RENA
Middle Name:AVITAL
Last Name:AHDUT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 VINTAGE CIR UNIT 1337
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6674
Mailing Address - Country:US
Mailing Address - Phone:253-226-1496
Mailing Address - Fax:
Practice Address - Street 1:565 SYCAMORE VALLEY RD W
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3900
Practice Address - Country:US
Practice Address - Phone:925-837-5595
Practice Address - Fax:935-837-6558
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34826111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor