Healthcare Provider Details

I. General information

NPI: 1538920145
Provider Name (Legal Business Name): RENEE D MINOR LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RENEE DIAZ LVN

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 RIO LINDO AVE
CHICO CA
95926-1817
US

IV. Provider business mailing address

7246 REMMET AVE
CANOGA PARK CA
91303-1531
US

V. Phone/Fax

Practice location:
  • Phone: 530-897-7056
  • Fax: 530-345-0261
Mailing address:
  • Phone: 818-206-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number714716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: