Provider Demographics
NPI:1487285243
Name:RENTERIA, CRISTA JUDE (LVN)
Entity type:Individual
Prefix:
First Name:CRISTA
Middle Name:JUDE
Last Name:RENTERIA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 N DATE ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3405
Mailing Address - Country:US
Mailing Address - Phone:760-745-7786
Mailing Address - Fax:
Practice Address - Street 1:3230 WARING CT STE A
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4509
Practice Address - Country:US
Practice Address - Phone:760-305-7528
Practice Address - Fax:760-509-4410
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALVN683245164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse