Provider Demographics
NPI:1548713738
Name:RENTERIA, ADELIDA
Entity type:Individual
Prefix:
First Name:ADELIDA
Middle Name:
Last Name:RENTERIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4836 47TH ST APT 5E
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7232
Mailing Address - Country:US
Mailing Address - Phone:718-669-0586
Mailing Address - Fax:
Practice Address - Street 1:4836 47TH ST APT 5E
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-7232
Practice Address - Country:US
Practice Address - Phone:718-669-0586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist