Provider Demographics
NPI:1720642366
Name:RENDON, ANITA (MA)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:RENDON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 E LA PALMA AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2085
Mailing Address - Country:US
Mailing Address - Phone:714-696-6321
Mailing Address - Fax:844-675-3501
Practice Address - Street 1:5150 E LA PALMA AVE STE 108
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2085
Practice Address - Country:US
Practice Address - Phone:714-696-6321
Practice Address - Fax:844-675-3501
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4273235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist