Basic Information
| Provider Information | |||||||||
| NPI: | 1952844979 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR. LAURA RENTERIA, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14631 SW MILLIKAN WAY | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970032999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9713307352 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14631 SW MILLIKAN WAY | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970032999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9713307352 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2016 | ||||||||
| LastUpdateDate: | 11/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | RENTERIA | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9713307352 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 2686 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.