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General NPI Number Information
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NPI Number | 1508025222
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Entity Type | Organization
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Legal Business Name | RENETTA LYNNICE HATCHER MD, INC.
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 15651 IMPERIAL HWY STE 207
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City | LA MIRADA
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State | CA
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Zip | 90638-1653
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Country | US
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Telephone | 562-902-8500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2278
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City | LA HABRA
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State | CA
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Zip | 90632-2278
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Country | US
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Telephone | 562-902-8500
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Fax |
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Authorized Official
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Title or Position | CEO / OWNER
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Name | RENETTA L. HATCHER
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Credential | MD
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Telephone | 562-902-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A063581
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License Number State | CA
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