Provider Demographics
NPI:1689059354
Name:RENTERIA, DENICE MABEL (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:DENICE
Middle Name:MABEL
Last Name:RENTERIA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 W IMPERIAL AVE APT 2
Mailing Address - Street 2:#2
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2137
Mailing Address - Country:US
Mailing Address - Phone:310-863-2734
Mailing Address - Fax:
Practice Address - Street 1:440 W IMPERIAL AVE
Practice Address - Street 2:#2
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2172
Practice Address - Country:US
Practice Address - Phone:310-863-2734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-10084103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst