Provider Demographics
NPI:1790410348
Name:OGINO, RENA (PA-C, MMS, MPH)
Entity Type:Individual
Prefix:
First Name:RENA
Middle Name:
Last Name:OGINO
Suffix:
Gender:F
Credentials:PA-C, MMS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6643
Mailing Address - Country:US
Mailing Address - Phone:714-494-5546
Mailing Address - Fax:
Practice Address - Street 1:1000 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4639
Practice Address - Country:US
Practice Address - Phone:323-346-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61386363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant