Healthcare Provider Details

I. General information

NPI: 1669394227
Provider Name (Legal Business Name): ALEXIS IVAN RENTERIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 SHUCKIN ST UNIT 105
HAMPSTEAD NC
28443-8731
US

IV. Provider business mailing address

425 DARLINGTON AVE
WILMINGTON NC
28403-1466
US

V. Phone/Fax

Practice location:
  • Phone: 910-599-2230
  • Fax:
Mailing address:
  • Phone: 919-758-1401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: