Healthcare Provider Details

I. General information

NPI: 1780933457
Provider Name (Legal Business Name): JODEE QUIRK RENTERIA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 SAVIERS RD
OXNARD CA
93033-3608
US

IV. Provider business mailing address

PO BOX 5771
VENTURA CA
93005-0771
US

V. Phone/Fax

Practice location:
  • Phone: 805-525-4699
  • Fax:
Mailing address:
  • Phone: 805-701-7027
  • Fax: 805-620-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: