Healthcare Provider Details

I. General information

NPI: 1346531829
Provider Name (Legal Business Name): ALEXANDER AUGUSTINE RENTERIA PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

594 NORTH GLASSELL ST. SUITE G
ORANGE CA
92867-6748
US

IV. Provider business mailing address

594 NORTH GLASSELL ST. SUITE G
ORANGE CA
92867-6748
US

V. Phone/Fax

Practice location:
  • Phone: 714-502-5691
  • Fax: 714-907-1670
Mailing address:
  • Phone: 714-502-5691
  • Fax: 714-907-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95037691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: