Healthcare Provider Details

I. General information

NPI: 1922370675
Provider Name (Legal Business Name): RENAE ANTONETTE ARCILLA RODRIGUEZ LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 LINCOLN GLEN DR
BUENA PARK CA
90620-4232
US

IV. Provider business mailing address

803 LINCOLN GLEN DR
BUENA PARK CA
90620-4232
US

V. Phone/Fax

Practice location:
  • Phone: 714-824-0787
  • Fax: 714-827-2698
Mailing address:
  • Phone: 714-824-0787
  • Fax: 714-827-2698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN 252646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: