Provider Demographics
NPI:1700567302
Name:RENSCH, LONDON MILAN (N/A)
Entity type:Individual
Prefix:
First Name:LONDON
Middle Name:MILAN
Last Name:RENSCH
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:LONDON
Other - Middle Name:MILAN
Other - Last Name:RENSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:65 KISKA RD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-5608
Mailing Address - Country:US
Mailing Address - Phone:415-760-8663
Mailing Address - Fax:
Practice Address - Street 1:1200 CONCORD AVE STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4969
Practice Address - Country:US
Practice Address - Phone:415-760-8663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician