Provider Demographics
NPI:1114723061
Name:RENDON, ELVIRA
Entity type:Individual
Prefix:
First Name:ELVIRA
Middle Name:
Last Name:RENDON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 BASALT DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2189
Mailing Address - Country:US
Mailing Address - Phone:707-346-7892
Mailing Address - Fax:
Practice Address - Street 1:560 BASALT DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2189
Practice Address - Country:US
Practice Address - Phone:707-346-7892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula