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NPI Code Detail

MEDICARE: MS. RENINA TRAYSHON DEEMINTER MFTI, M.A.

MEDICARE: MS. RENINA TRAYSHON DEEMINTER MFTI, M.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistIMF45724CA
2106H00000XMarriage & Family TherapistIMF87853CA
3225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1205967064
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RENINA TRAYSHON DEEMINTER MFTI, M.A.
Provider Business Mailing Address
First Line : 1000 GOODRICH BLVD
Second Line :
City : COMMERCE
State : CA
Zip : 90022-5103
Country : US
Telephone Number : 323-832-9795
Fax Number : 323-832-9796
Provider Business Practice Location Address
First Line : 1000 GOODRICH BLVD
Second Line :
City : COMMERCE
State : CA
Zip : 90022-5103
Country : US
Telephone Number : 323-832-9795
Fax Number : 323-832-9796
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 08/11/2016

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