Provider Demographics
NPI:1245418896
Name:FLANAGAN, RENEE DENISE (MA)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:DENISE
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N MOUNTAIN AVE STE 222
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5191
Mailing Address - Country:US
Mailing Address - Phone:800-675-5485
Mailing Address - Fax:909-931-1071
Practice Address - Street 1:400 N MOUNTAIN AVE STE 222
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5191
Practice Address - Country:US
Practice Address - Phone:800-675-5485
Practice Address - Fax:909-931-1071
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1470174400000X
CAHA3228174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist