Provider Demographics
NPI:1760646582
Name:SARNADI, RETNO NOVIASTUTI
Entity Type:Individual
Prefix:
First Name:RETNO
Middle Name:NOVIASTUTI
Last Name:SARNADI
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 1:42 N MICHIGAN AVE UNIT 11
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1847
Mailing Address - Country:US
Mailing Address - Phone:818-667-4439
Mailing Address - Fax:
Practice Address - Street 1:2550 FOOTHILL BLVD
Practice Address - Street 2:2ND FL
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107
Practice Address - Country:US
Practice Address - Phone:626-744-5230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No374700000XNursing Service Related ProvidersTechnician