Provider Demographics
NPI:1639890916
Name:RENTERIA, LAZARO JR
Entity Type:Individual
Prefix:
First Name:LAZARO
Middle Name:
Last Name:RENTERIA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49211 GRAPEFRUIT BLVD STE 5&6
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-1480
Mailing Address - Country:US
Mailing Address - Phone:760-541-8520
Mailing Address - Fax:
Practice Address - Street 1:49211 GRAPEFRUIT BLVD STE 5&6
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1480
Practice Address - Country:US
Practice Address - Phone:760-541-8520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health