Provider Demographics
NPI:1720299068
Name:HATCHER, RENETTA L (MD)
Entity Type:Individual
Prefix:DR
First Name:RENETTA
Middle Name:L
Last Name:HATCHER
Suffix:
Gender:F
Credentials:MD
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 2278
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90632-2278
Mailing Address - Country:US
Mailing Address - Phone:562-902-8500
Mailing Address - Fax:
Practice Address - Street 1:15651 IMPERIAL HWY
Practice Address - Street 2:STE 207
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1628
Practice Address - Country:US
Practice Address - Phone:562-902-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA063581208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16336Medicare ID - Type Unspecified
CAH80042Medicare UPIN