Provider Demographics
NPI:1407002074
Name:SATRIJO, RENISA C (OD)
Entity Type:Individual
Prefix:
First Name:RENISA
Middle Name:C
Last Name:SATRIJO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 EL CAMINO REAL
Mailing Address - Street 2:160 MENLO STATION
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4847
Mailing Address - Country:US
Mailing Address - Phone:650-329-8181
Mailing Address - Fax:
Practice Address - Street 1:700 EL CAMINO REAL
Practice Address - Street 2:160 MENLO STATION
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4847
Practice Address - Country:US
Practice Address - Phone:650-329-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12926152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist