Provider Demographics
NPI:1396117230
Name:RESENDEZ, RENEE RAQUEL
Entity type:Individual
Prefix:MISS
First Name:RENEE
Middle Name:RAQUEL
Last Name:RESENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 WHITEHALL CT
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-6322
Mailing Address - Country:US
Mailing Address - Phone:925-321-3045
Mailing Address - Fax:
Practice Address - Street 1:3701 LONE TREE WAY
Practice Address - Street 2:STE. 7
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6038
Practice Address - Country:US
Practice Address - Phone:925-778-3800
Practice Address - Fax:925-778-3915
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist