Provider Demographics
NPI:1821876772
Name:RENTERIA, LESLIE CAROL (RBT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:CAROL
Last Name:RENTERIA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11311 BARBAROSA DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-2118
Mailing Address - Country:US
Mailing Address - Phone:214-498-6398
Mailing Address - Fax:
Practice Address - Street 1:1675 REPUBLIC PKWY STE 104
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6902
Practice Address - Country:US
Practice Address - Phone:214-817-2457
Practice Address - Fax:214-393-5875
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician