Provider Demographics
NPI:1134889330
Name:RENKOR, EDWARD JAMES
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JAMES
Last Name:RENKOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10714 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2709
Mailing Address - Country:US
Mailing Address - Phone:562-500-3443
Mailing Address - Fax:
Practice Address - Street 1:10714 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2709
Practice Address - Country:US
Practice Address - Phone:562-500-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst