Individual
DEITRA RENEE POUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
222 E MAIN ST, BARSTOW, CA 92311-2361
(760) 255-1496
Mailing address
12476 DEODAR ST, VICTORVILLE, CA 92392-4838
(760) 514-5244
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
12/18/2024
Last updated
11/19/2025
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