Provider Demographics
NPI:1487286696
Name:RETAMAR, SYDNEY RENEE
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:RENEE
Last Name:RETAMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PACIFICA APT 6236
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3364
Mailing Address - Country:US
Mailing Address - Phone:760-835-9778
Mailing Address - Fax:
Practice Address - Street 1:1404 N TUSTIN AVE STE 225
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8632
Practice Address - Country:US
Practice Address - Phone:714-221-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 172V00000X
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst