Healthcare Provider Details

I. General information

NPI: 1306677570
Provider Name (Legal Business Name): MRS. RANDI L WREN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 PRIMROSE RD STE 205
BURLINGAME CA
94010-4026
US

IV. Provider business mailing address

330 PRIMROSE RD STE 205
BURLINGAME CA
94010-4026
US

V. Phone/Fax

Practice location:
  • Phone: 650-477-8810
  • Fax:
Mailing address:
  • Phone: 650-477-8810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: