Provider Demographics
NPI:1396972097
Name:JAROSZ, RENATA (DO, MS)
Entity type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:JAROSZ
Suffix:
Gender:F
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 UNIVERSITY DR STE 6
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4254
Mailing Address - Country:US
Mailing Address - Phone:650-494-4467
Mailing Address - Fax:
Practice Address - Street 1:1300 UNIVERSITY DR STE 6
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4254
Practice Address - Country:US
Practice Address - Phone:650-494-4467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11363208100000X
NY274346121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine