Individual
BRENDA RENTERIA LOERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
801 POLE LINE RD W STE 3880, TWIN FALLS, ID 83301-5811
(208) 814-8500
(208) 814-8960
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2663
ID
363A00000X
Physician Assistant
—
—
Other
Enumeration date
06/17/2022
Last updated
12/05/2023
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