Individual
DR. RENA A. STATHACOPOULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
234 HEATHER CT, SUITE 102, TEMPLETON, CA 93465-8765
(805) 434-5970
(805) 434-5973
Mailing address
234 HEATHER CT, SUITE 102, TEMPLETON, CA 93465-8765
(805) 434-5970
(805) 434-5973
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
G65410
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G654100
—
CA
Enumeration date
07/31/2006
Last updated
01/15/2015
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