Provider Demographics
NPI:1588026405
Name:RENDON, DANIEL (BA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:RENDON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2847
Mailing Address - Country:US
Mailing Address - Phone:405-664-2437
Mailing Address - Fax:
Practice Address - Street 1:116 SW 28TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2847
Practice Address - Country:US
Practice Address - Phone:405-664-2437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst