Provider Demographics
NPI:1831495738
Name:RHEA, RENNA R (LAC , RN)
Entity Type:Individual
Prefix:MS
First Name:RENNA
Middle Name:R
Last Name:RHEA
Suffix:
Gender:F
Credentials:LAC , RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3731 S CANFIELD AVE
Mailing Address - Street 2:#1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4138
Mailing Address - Country:US
Mailing Address - Phone:310-836-8858
Mailing Address - Fax:310-836-1102
Practice Address - Street 1:99 S CHESTER AVE
Practice Address - Street 2:100
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-5804
Practice Address - Country:US
Practice Address - Phone:626-356-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN359391163WH0200X
CAAC7694171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163WH0200XNursing Service ProvidersRegistered NurseHome Health