Healthcare Provider Details

I. General information

NPI: 1295620565
Provider Name (Legal Business Name): MR. ADAM FRANK RENTERIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3845 SPRING DR
SPRING VALLEY CA
91977-1030
US

IV. Provider business mailing address

8787 COMPLEX DR STE 300
SAN DIEGO CA
92123-1453
US

V. Phone/Fax

Practice location:
  • Phone: 619-797-1090
  • Fax: 619-281-3714
Mailing address:
  • Phone: 619-797-1090
  • Fax: 619-281-3714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: