MEDICARE: RODOLFO RENTERIA ED.S NCSP

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
1	103TS0200X	School Psychologist	1171125	IL

General Provider Information

NPI Number	:	1669320032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODOLFO RENTERIA ED.S NCSP

Provider Business Mailing Address
First Line	:	214 E BAILEY RD APT M
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-1462
Country	:	US
Telephone Number	:	708-435-1555
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 E BAILEY RD APT M
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-1462
Country	:	US
Telephone Number	:	708-435-1555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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