Provider Demographics
NPI:1568794972
Name:DERIENZO, TINA LOUISE (CPRP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:LOUISE
Last Name:DERIENZO
Suffix:
Gender:F
Credentials:CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37642 LEMSFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-5694
Mailing Address - Country:US
Mailing Address - Phone:661-547-6449
Mailing Address - Fax:
Practice Address - Street 1:506 W JACKMAN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2531
Practice Address - Country:US
Practice Address - Phone:661-726-2850
Practice Address - Fax:661-579-8367
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner