Healthcare Provider Details

I. General information

NPI: 1790410348
Provider Name (Legal Business Name): RENA OGINO PA-C, MMS, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W WHITTIER BLVD
MONTEBELLO CA
90640-4639
US

IV. Provider business mailing address

406 PINE AVE
BREA CA
92821-6643
US

V. Phone/Fax

Practice location:
  • Phone: 323-346-0555
  • Fax:
Mailing address:
  • Phone: 714-494-5546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number61386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: