Provider Demographics
NPI:1669594271
Name:RENTA, KRISTA BARRETT (ASW, MSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:BARRETT
Last Name:RENTA
Suffix:
Gender:F
Credentials:ASW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13424 REVA CIR
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8920
Mailing Address - Country:US
Mailing Address - Phone:562-212-5040
Mailing Address - Fax:
Practice Address - Street 1:460 E CARSON PLAZA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3228
Practice Address - Country:US
Practice Address - Phone:310-523-9500
Practice Address - Fax:310-225-2725
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 243071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACBSC582OtherLA DMH PROVIDER
CA00007570Medicaid