Healthcare Provider Details

I. General information

NPI: 1487285243
Provider Name (Legal Business Name): CRISTA JUDE RENTERIA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 WARING CT STE A
OCEANSIDE CA
92056-4509
US

IV. Provider business mailing address

161 N DATE ST
ESCONDIDO CA
92025-3405
US

V. Phone/Fax

Practice location:
  • Phone: 760-305-7528
  • Fax: 760-509-4410
Mailing address:
  • Phone: 760-745-7786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberLVN683245
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: