Provider Demographics
NPI:1346909314
Name:RENTERIA, JESLENE MARIA (DC)
Entity Type:Individual
Prefix:
First Name:JESLENE
Middle Name:MARIA
Last Name:RENTERIA
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 1:10921 BOUDREAUX RD APT 1306
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-7335
Mailing Address - Country:US
Mailing Address - Phone:210-739-2880
Mailing Address - Fax:
Practice Address - Street 1:142 1ST ST W
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3619
Practice Address - Country:US
Practice Address - Phone:832-644-1589
Practice Address - Fax:713-644-1739
Is Sole Proprietor?:No
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor