Provider Demographics
NPI:1558382051
Name:RENTERIA, SALVADOR PAUL III (DO)
Entity Type:Individual
Prefix:
First Name:SALVADOR
Middle Name:PAUL
Last Name:RENTERIA
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3100 RUBINO DR APT 113
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-6368
Mailing Address - Country:US
Mailing Address - Phone:408-269-3049
Mailing Address - Fax:
Practice Address - Street 1:7174 SANTA TERESA BLVD STE A6
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95139-1350
Practice Address - Country:US
Practice Address - Phone:408-363-1498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8406208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH56712Medicare UPIN