Individual
DEZTINE K THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
24910 LAS BRISAS RD STE 117, MURRIETA, CA 92562-4035
(951) 465-3664
Mailing address
21600 OXNARD ST STE 1800, WOODLAND HILLS, CA 91367-7807
(818) 345-2345
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235649260
—
CA
Enumeration date
06/13/2018
Last updated
02/05/2025
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