Provider Demographics
NPI:1275953812
Name:RENTAS, KORI MARIE (TEACHER)
Entity Type:Individual
Prefix:
First Name:KORI
Middle Name:MARIE
Last Name:RENTAS
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 W DAYTON ST
Mailing Address - Street 2:APT 409
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2080
Mailing Address - Country:US
Mailing Address - Phone:630-418-3284
Mailing Address - Fax:
Practice Address - Street 1:65 W DAYTON ST
Practice Address - Street 2:APT 409
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2080
Practice Address - Country:US
Practice Address - Phone:630-418-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program