Provider Demographics
NPI:1134494057
Name:RENTERIA, MARIA I (LVN)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:I
Last Name:RENTERIA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:I
Other - Last Name:RENTERIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:4045 N FRUIT AVE
Mailing Address - Street 2:APT 201
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-2155
Mailing Address - Country:US
Mailing Address - Phone:559-363-8069
Mailing Address - Fax:
Practice Address - Street 1:4045 N FRUIT AVE
Practice Address - Street 2:APT 201
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-2155
Practice Address - Country:US
Practice Address - Phone:559-363-8069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 253277164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse