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NPI Code Detail

MEDICARE: RENAE DAHLQUIST RBT

MEDICARE: RENAE DAHLQUIST RBT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-18-56916CA

General Provider Information

NPI Number : 1619456365
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENAE DAHLQUIST RBT
Provider Business Mailing Address
First Line : 4146 UNIVERSITY AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92501-3140
Country : US
Telephone Number : 626-353-8933
Fax Number : 626-602-3875
Provider Business Practice Location Address
First Line : 4146 UNIVERSITY AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92501-3140
Country : US
Telephone Number : 626-353-8933
Fax Number : 626-602-3875
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2018
Last Update Date : 08/13/2018

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Directions to “ RENAE DAHLQUIST RBT” Practice Location

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