Healthcare Provider Details

I. General information

NPI: 1932972080
Provider Name (Legal Business Name): GRICET RENTERIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR STE 210
OXNARD CA
93036-2612
US

IV. Provider business mailing address

1911 WILLIAMS DR
OXNARD CA
93036-2612
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-9204
  • Fax:
Mailing address:
  • Phone: 805-981-9204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: