Renew U Therapy

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

RENEW U THERAPY

Practice address

12319 Mount Vernon Ave
Grand Terrace, CA 92313

Phone

(951) 217-9363

NPI assigned

Apr 12, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Siamak Ehteshamzadeh, DR.NPI 1508116518

Title

Ceo

Phone

(951) 217-9363

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Siamak Ehteshamzadeh, PSYD

  • Addiction (Substance Use Disorder) Counselor
  • Moreno Valley, CA
  • NPI 1508116518
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1744416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744416000000",
    "number": "1366237000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8461",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925528461",
            "telephone_number": "951-217-9363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12319 MOUNT VERNON AVE",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "92313",
            "telephone_number": "951-217-9363"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25320 Lurin Ave",
            "address_purpose": "LOCATION",
            "city": "Moreno Valley",
            "state": "CA",
            "postal_code": "925512405",
            "country_code": "US",
            "telephone_number": "951-217-9363",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RENEW U THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-12",
        "last_updated": "2025-04-12",
        "certification_date": "2025-04-12",
        "status": "A",
        "authorized_official_last_name": "EHTESHAMZADEH",
        "authorized_official_first_name": "SIAMAK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "951-217-9363",
        "authorized_official_credential": "DR."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nivedita Rajakumar, MS, LCGC, MA
• Victor Godfrey Ramirez
• Rajdeep K Randhawa, D.D.S
• Royke Rantung
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• Jennifer Reyes
• Denise Reynolds
• Rise Forward Speech Therapy, Inc
• Riverside-San Bernardino County Indian Health Inc (San Manuel Indian Health Clinic Pharmacy)
• Riverside-San Bernardino County Indian Health, Inc. (San Manuel Indian Health)

• Substance Abuse Rehabilitation Facility in Grand Terrace, CA
• Providers in Grand Terrace, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.