Provider Demographics
NPI:1629663158
Name:NYABUTI, RENORA S
Entity Type:Individual
Prefix:
First Name:RENORA
Middle Name:S
Last Name:NYABUTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 35TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-4200
Mailing Address - Country:US
Mailing Address - Phone:510-289-0671
Mailing Address - Fax:
Practice Address - Street 1:155 GRAND AVE STE 500
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3747
Practice Address - Country:US
Practice Address - Phone:510-987-8256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst