Provider Demographics
NPI:1730980129
Name:RENNEISEN, JAY (LICENSED ATTORNEY)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:RENNEISEN
Suffix:
Gender:
Credentials:LICENSED ATTORNEY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 R ST STE 220
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-6682
Mailing Address - Country:US
Mailing Address - Phone:925-890-2700
Mailing Address - Fax:
Practice Address - Street 1:1610 R ST STE 220
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-6682
Practice Address - Country:US
Practice Address - Phone:925-890-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA173531209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA173531OtherSTATE BAR OF CALIFORNIA