Provider Demographics
NPI:1700261054
Name:RENTERIA, JESUSCHRISTOPHER RODRIGUEZ (CNIM)
Entity Type:Individual
Prefix:
First Name:JESUSCHRISTOPHER
Middle Name:RODRIGUEZ
Last Name:RENTERIA
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1577
Mailing Address - Street 2:SUITE 915
Mailing Address - City:WALLER
Mailing Address - State:TX
Mailing Address - Zip Code:77484-1577
Mailing Address - Country:US
Mailing Address - Phone:888-344-2947
Mailing Address - Fax:
Practice Address - Street 1:2300 VALLEY VIEW LN
Practice Address - Street 2:SUITE 915
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-1721
Practice Address - Country:US
Practice Address - Phone:818-568-9963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3053246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic