Provider Demographics
NPI:1982736351
Name:WILLIAM H RADENTZ MD
Entity Type:Organization
Organization Name:WILLIAM H RADENTZ MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RADENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-600-3946
Mailing Address - Street 1:39755 MURRIETA HOT SPRINGS ROAD
Mailing Address - Street 2:SUITE A130
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563
Mailing Address - Country:US
Mailing Address - Phone:951-600-3946
Mailing Address - Fax:951-304-2203
Practice Address - Street 1:39755 MURRIETA HOT SPRINGS ROAD
Practice Address - Street 2:SUITE A130
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563
Practice Address - Country:US
Practice Address - Phone:951-600-3946
Practice Address - Fax:951-304-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC504460207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C504460OtherBLUE SHIELD
CA4227758OtherAETNA
CA00C504460OtherBLUE CROSS
CA00C504460OtherBLUE SHIELD
CA00C504460Medicare ID - Type Unspecified