Healthcare Provider Details

I. General information

NPI: 1215270905
Provider Name (Legal Business Name): JOSEPH JACOB RENTERIA MHRW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 N BLACKSTONE ST
TULARE CA
93274-4449
US

IV. Provider business mailing address

426 N BLACKSTONE ST
TULARE CA
93274-4449
US

V. Phone/Fax

Practice location:
  • Phone: 559-688-2021
  • Fax: 559-687-7317
Mailing address:
  • Phone: 559-688-2021
  • Fax: 559-687-7317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW129377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: