Healthcare Provider Details

I. General information

NPI: 1205882701
Provider Name (Legal Business Name): CHRISTINE J RENTZ P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: CHRISTINE J BURCH P.A.

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E COOLEY DR
COLTON CA
92324-3905
US

IV. Provider business mailing address

PO BOX 2200
REDLANDS CA
92373-0722
US

V. Phone/Fax

Practice location:
  • Phone: 909-370-4100
  • Fax: 909-796-4158
Mailing address:
  • Phone: 909-793-3311
  • Fax: 909-796-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: