Healthcare Provider Details

I. General information

NPI: 1770999435
Provider Name (Legal Business Name): MRS. JEANETTE RENDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR STE 150
OXNARD CA
93036-2612
US

IV. Provider business mailing address

4853 COLONY DR
CAMARILLO CA
93012-5205
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-8460
  • Fax:
Mailing address:
  • Phone: 805-377-5422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60962009
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: