=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831495738
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENNA R RHEA L.AC. , R.N.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2011
-----------------------------------------------------
Last Update Date | 02/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 99 S CHESTER AVE 100
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91106-5804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-356-3220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3731 S CANFIELD AVE #1
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90034-4138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-836-8858
-----------------------------------------------------
Fax | 310-836-1102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number | RN359391
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC7694
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------