Doctor Name: | GARY JOHN RENZAGLIA |
NPI Number: | 1073543716 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | PSY10484 |
Business Practice Address: | 10333 El Camino Real Atascadero, CA - 934225808 |
Business Phone Number: | 8054682000 |
Business Fax Number: | 8054686011 |
Mailing Address: | 1600 9th St, Room 150 Fiscal Allocations And Estimates Unit SACRAMENTO |
State: | CA |
Postal Code: | 958146414 |
Phone Number: | 9166519475 |
Fax Number: | 9166518908 |
NPI Enumeration Date: | 07/04/2006 |
NPI Last Update Date: | 07/15/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC1900X |
License Number: | PSY10484 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Counseling |
Taxonomy Definition: |