Provider Demographics
NPI:1255529939
Name:RENSULAT, KATHERINE JOY (RDHAP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JOY
Last Name:RENSULAT
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 CUMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4019
Mailing Address - Country:US
Mailing Address - Phone:510-435-7956
Mailing Address - Fax:925-988-8010
Practice Address - Street 1:818 CUMBERLAND DR
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4019
Practice Address - Country:US
Practice Address - Phone:510-435-7956
Practice Address - Fax:925-988-8010
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA160124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist