Healthcare Provider Details

I. General information

NPI: 1073068623
Provider Name (Legal Business Name): RENA SHENG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 W ALLUVIAL AVE
FRESNO CA
93711-5509
US

IV. Provider business mailing address

1739 7TH AVE
SAN FRANCISCO CA
94122-4705
US

V. Phone/Fax

Practice location:
  • Phone: 559-432-9800
  • Fax:
Mailing address:
  • Phone: 214-502-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number74905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: