Provider Demographics
NPI:1659729143
Name:RENTERIA, LAURA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:RENTERIA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14943 GAGELY DR APT 6
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-2131
Mailing Address - Country:US
Mailing Address - Phone:562-843-0999
Mailing Address - Fax:
Practice Address - Street 1:12411 SLAUSON AVE
Practice Address - Street 2:SUITE H
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2835
Practice Address - Country:US
Practice Address - Phone:562-693-5449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29497235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist