Provider Demographics
NPI:1891584199
Name:RENTERIA, RENAE (CMT)
Entity type:Individual
Prefix:
First Name:RENAE
Middle Name:
Last Name:RENTERIA
Suffix:
Gender:
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7141 ROUSE CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95139-1345
Mailing Address - Country:US
Mailing Address - Phone:408-464-4779
Mailing Address - Fax:
Practice Address - Street 1:7176 SANTA TERESA BLVD STE B7
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95139-1351
Practice Address - Country:US
Practice Address - Phone:408-372-7757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73050225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist