Provider Demographics
NPI:1750964722
Name:RENAISSANCE BEHAVIORAL MEDICINE
Entity type:Organization
Organization Name:RENAISSANCE BEHAVIORAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ETEFIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-206-8932
Mailing Address - Street 1:8500 WILSHIRE BLVD STE 520
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3111
Mailing Address - Country:US
Mailing Address - Phone:213-262-0888
Mailing Address - Fax:855-347-9258
Practice Address - Street 1:8500 WILSHIRE BLVD STE 520
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3111
Practice Address - Country:US
Practice Address - Phone:213-262-0888
Practice Address - Fax:855-347-9258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty