Provider Demographics
NPI:1508025222
Name:RENETTA LYNNICE HATCHER MD, INC.
Entity Type:Organization
Organization Name:RENETTA LYNNICE HATCHER MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENETTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-902-8500
Mailing Address - Street 1:PO BOX 2278
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90632-2278
Mailing Address - Country:US
Mailing Address - Phone:562-902-8500
Mailing Address - Fax:
Practice Address - Street 1:15651 IMPERIAL HWY STE 207
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1653
Practice Address - Country:US
Practice Address - Phone:562-902-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA063581208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16336Medicare PIN
CAH80042Medicare UPIN